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[Periventricular leukomalacia: its retrospective diagnosis in children with spastic diplegia]
J Campistol Plana1, C Escofet Soteras, P Póo Argüelles
1Servicio de Neuropediatría, Unidad Integrada Hospital Clinic-Sant Joan de Déu, Barcelona.
Insights
Computed Tomography (CT) scans can retrospectively diagnose periventricular leukomalacia (PVL) in children with spastic diplegia, even when early imaging is inconclusive. This highlights CT
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Periventricular leukomalacia (PVL) is a significant cause of neurological impairment in children, particularly those with spastic diplegia.
- Early diagnosis of PVL is crucial for timely intervention, but neonatal imaging methods may not always detect residual changes.
Purpose of the Study:
- To identify typical CT scan findings indicative of residual PVL in children diagnosed with spastic diplegia.
- To evaluate the diagnostic utility of CT scans for retrospective PVL diagnosis, especially when neonatal imaging was negative or unavailable.
Main Methods:
- Retrospective review of CT scans from 135 children with spastic diplegia.
- Analysis of imaging findings, correlating them with clinical context and available early diagnostic reports (cranial ultrasound, initial CT).
- Magnetic Resonance Imaging (MRI) was used in a subset of cases for diagnostic confirmation.
Main Results:
- Of 135 children, 90 had CT scans, with 51 (56.6%) showing findings consistent with residual PVL.
- Only a small fraction of these PVL cases were identified by neonatal cranial ultrasound (11.7%) or initial CT (21.5%).
- A significant majority (66.6%) were diagnosed retrospectively via CT, with specific findings like ventricular dilation and atrophy noted.
Conclusions:
- CT scan examination is vital for the retrospective diagnosis of residual PVL in older children, especially those without prior neonatal imaging.
- Subtle CT findings such as slight ventricular dilation, normotensive hydrocephalus, irregular hydrocephalus, subcortical atrophy, or periventricular heterotopia can indicate residual PVL.
- CT plays a crucial role in identifying PVL in cases where early cranial ultrasound was not performed or was inconclusive.
Abstract:
Typical images of residual periventricular leukomalacia (PVL) have been searched for in a review of the CT scans of 135 children with spastic diplegia. Among the 135 children studied, 90 (66.6%) of them had had a CT scan with 51 (56.6%) showing typical images of residual PVL. Only 6 (11.7%) of these 51 children were identified in the early stages by cranial ultrasound and 11 (21.5%) of the 51 were diagnosed by CT scan. The remaining 34 (66.6%) were diagnosed retrospectively during our study and none of them were identified as PVL in the first examination by CT scan. In addition to CT scan examination, 3 children were explored by MRI that confirmed the diagnosis of PVL. The results of our study indicate that images in CT scans reported as slight ventricular dilation, normotensive hydrocephalus, hydrocephalus with irregular limits, subcortical atrophy or periventricular heterotopia could corresponds to images of residual PVL in the appropriate context. We emphasize the importance of CT scan examination for the retrospective diagnosis of PVL in elder children in which cranial ultrasound examination had not been performed during the neonatal period.