15 months old female baby with delayed developental milestones.
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Bilateral symmetrical butterfly-shaped T2 prolongation of the peri-ventricular and deep white matter with relative sparing of the subcortical U-fibers. The lesion shows hypointense T1 and hyperintense T2 / FLAIR signal with characteristic tigroid pattern. No evident post-contrast enhancement. The lesion shows evident restricted diffusion with high DWI and low ADC signal.
MR spectroscopy examination of the lesion shows elevation of the choline (Cho), myoinositol (MI) and lipid / lactate with depression of the N-acetyl aspartate (NAA).
This case shows dysmyelinating white matter disease, with the above described conventional and MR spectroscopic criteria are typical of metachromatic leucodystrophy (MLD).
- Cheon JE, Kim IO, Hwang YS et-al. Leukodystrophy in children: a pictorial review of MR imaging features. Radiographics. 22 (3): 461-76. Radiographics (full text) - Pubmed citation
- Eichler F, Grodd W, Grant E et-al. Metachromatic leukodystrophy: a scoring system for brain MR imaging observations. AJNR Am J Neuroradiol. 2009;30 (10): 1893-7. doi:10.3174/ajnr.A1739 - Pubmed citation