Central tegmental tract high T2 signal
The central tegmental tract refers mainly to the extrapyramidal tracts connecting between the red nucleus and the inferior olivary nucleus. This tract is one of the earliest regions in which myelination begins (9 months after conception) (3). The symmetrical CTT hyperintensities seen on T2-weighted images are an uncommon imagiologic finding (2).
The symmetrical central tegmental tract hyperintensity occurs more frequently during the early childhood between 1 and 5 years of age 2,3. It is encountered in a variety of settings including 2:
Occasionally it is found in children with no clinical neurological finding 2,3.
The aetiology of high T2 signal is unclear. Numerous theories for the pathogenesis have been suggested, for including intramyelination oedema, gliosis or secondary degeneration of the cerebral white matter 1.
Some authors, instead, have suggested that the majority of imaging findings simply represent a physiological maturation-related process 3.
- T2: symmetrical hyperintensities in the central tegmental tracts
- DWI/ADC: may show restricted diffusion
Treatment and prognosis
The meaning of this finding, its clinical correlation with various neurologic deficits and prognosis remains unclear, and in some instances it is reversible 3,4.
- 1. Yoshida S, Hayakawa K, Yamamoto A, Aida N, Okano S, Matsushita H, et al. Symmetrical central tegmental tract (CTT) hyperintense lesions on magnetic resonance imaging in children. Eur Radiol. 2009;19:462–9. DOI 10.1007/s00330-008-1167-7
- 2. Paramdeep S, Amarpreet K, Rupinderjeet K, Simmi A, Ramandeep S. Journal of Pediatric Neurosciences 2015; 10(3): 235–236. doi: 10.4103/1817-1745.165666
- 3. Sergio A, Andrea P, D Honnef, Meral A, Maria Eugenia YP, Thierry H, Martin H. T2 hyperintense signal of the central tegmental tracts in children: disease or normal maturational process? Neuroradiology 2012; 54 (8):863-71; DOI 10.1007/s00234-012-1006-z
- 4. J. Takanashi, M. Manazawa, Y. Kohno. Central tegmental tract involve- ment in an infant with 6-pyruvoylte- trahydropterin synthetase deficiency. AJNR Am J Neuroradiol 2006; 27:584–585.