Frontal lobe-dominant cerebral blood flow reduction and atrophy can be progressive in Duchenne muscular dystrophy

This study aimed to clarify the characteristics and progressive changes of brain image abnormalities in Duchenne muscular dystrophy (DMD). Brain images of 39 adult patients (median age, 24 years) were retrospectively reviewed, along with intellectual and/or neurodevelopmental test results. On magnetic resonance imaging (n = 13), atrophy of the frontal lobe, pars opercularis (without other frontal atrophy), and cerebellum was observed in 6, 1, and 1 patients, respectively. On computed tomography (n = 32), atrophy of the frontal lobe, pars opercularis, temporal lobe, and occipital lobe was observed in 20, 1, 1, and 1 patients, respectively. Re-imaging of 12 patients revealed progression of cerebral atrophy in 6. All 18 patients who underwent single photon emission computed tomography had reduced total and/or focal blood flow. Reduced total cerebral blood flow was observed significantly more frequently in patients with deleterious Dp140 mutations compared to those without. Re-examination 4 years later revealed worsening of reduced blood flow in the frontotemporal lobe in 1 patient. Abnormalities were detected by at least one imaging modality in 32 of 39 patients. No significant relationship was observed between imaging abnormalities and developmental disorders or intelligence quotient. In conclusion, DMD patients frequently exhibit frontal lobe-dominant cerebral blood flow reduction and atrophy, and may be at risk of progressive cerebral atrophy and reduced cerebral blood flow. MRI, CT, and/or brain single photon emission CT are useful for detecting brain abnormalities in adult DMD patients.