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Neuroimaging patterns in patients with mitochondrial leukoencephalopathies.

Sonal Sharma1, James Peterson2, Cesar Augusto Alves3

  • 1Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States of America; Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States of America; Division of Child Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States of America.

Journal of the Neurological Sciences
|July 13, 2025
PubMed
Summary

Mitochondrial diseases (MD) can cause leukoencephalopathy, affecting white matter (WM). Specific MRI patterns in pediatric patients can help identify genetic causes of these WM abnormalities.

Keywords:
LeukoencephalopathiesNeuroimagingPrimary mitochondrial diseaseWhite matter changes

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Area of Science:

  • Neuroscience
  • Genetics
  • Radiology

Background:

  • Leukoencephalopathies involve white matter (WM) abnormalities.
  • Primary mitochondrial diseases (MD) impact mitochondrial function in neuroglial cells.
  • Understanding WM abnormalities in MD is crucial for clinical management.

Purpose of the Study:

  • To identify specific neuroimaging patterns of white matter (WM) involvement in pediatric patients with genetically confirmed mitochondrial diseases (MD).
  • To correlate these patterns with genetic etiologies for improved diagnostic accuracy.

Main Methods:

  • Retrospective analysis of 192 genetically confirmed MD patients.
  • Review of neuroimaging (MRI) data for 142 patients, focusing on WM and other brain structures.
  • Collection of demographic, genetic, and biomarker data (CSF protein, plasma lactate).
  • Statistical analysis to correlate MRI features with genetic mutations (mtDNA vs. nDNA).

Main Results:

  • 30% of MD patients (43/142) exhibited white matter abnormalities.
  • Common WM findings included periventricular, diffuse, and multifocal lesions, with corpus callosum involvement in 51%.
  • Observed patterns included cystic changes (19%), diffusion restriction (42%), and WM volume loss (40%).
  • Genetic analysis revealed mutations in nDNA (70%) more frequently than mtDNA (30%).

Conclusions:

  • Specific neuroimaging patterns are associated with leukoencephalopathies in mitochondrial diseases (MD).
  • Examples include periventricular involvement in MTRFR mutations and diffuse abnormalities in FBXL4 mutations.
  • These findings aid clinicians in identifying genetic etiologies based on WM manifestations in MD patients.