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Papandreou A, Soo AKS, Spaull R, Mankad K, Kurian MA, Sudhakar S. Expanding the Spectrum of Early Neuroradiologic Findings in β Propeller Protein-Associated Neurodegeneration. AJNR Am J Neuroradiol 2022; 43:1810-1814. [PMID: 36328404 DOI: 10.3174/ajnr.a7693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE β propeller protein-associated neurodegeneration (BPAN) is the most common neurodegeneration with brain iron accumulation disorder. Typical radiologic findings are T2 hypointensity in the substantia nigra and globus pallidus, as well as a T1 halolike substantia nigra hyperintense signal surrounding a hypointense central area. However, these findings are often subtle or absent on initial scans, risking diagnostic delay. In this study, we sought to investigate radiologic findings that could aid in the early diagnosis of BPAN. MATERIALS AND METHODS A retrospective cohort study was performed in a national referral center, including all pediatric patients with confirmed pathogenic WDR45 mutations and consistent clinical semiology. MR imaging findings were independently reported by 2 pediatric neuroradiologists. RESULTS Fifteen patients were included in the study, and 27 scans were available for review. The initial neuroimaging study was undertaken at a mean age of 3.2 years. Iron deposition was uncommon in patients younger than 4 years of age. Neuroradiologic features from very early on included dentate, globus pallidus, and substantia nigra swelling, as well as a thin corpus callosum and small pontine volume. Optic nerve thinning was also present in all patients. CONCLUSIONS Our study highlights the key early MR imaging features of BPAN. Iron deposition in the globus pallidus and substantia nigra is not common in children younger than 4 years of age; clinicians should not be deterred from suspecting BPAN in the presence of the findings described in this study and the appropriate clinical context.
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Affiliation(s)
- A Papandreou
- From the Molecular Neurosciences (A.P., A.K.S.S., R.S., M.A.K.), Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK .,Departments of Neurology (A.P., A.K.S.S., R.S., M.A.K.)
| | - A K S Soo
- From the Molecular Neurosciences (A.P., A.K.S.S., R.S., M.A.K.), Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK.,Departments of Neurology (A.P., A.K.S.S., R.S., M.A.K.)
| | - R Spaull
- From the Molecular Neurosciences (A.P., A.K.S.S., R.S., M.A.K.), Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK.,Departments of Neurology (A.P., A.K.S.S., R.S., M.A.K.)
| | - K Mankad
- Neuroradiology (K.M., S.S.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
| | - M A Kurian
- From the Molecular Neurosciences (A.P., A.K.S.S., R.S., M.A.K.), Developmental Neurosciences Programme, Zayed Centre for Research into Rare Disease in Children, University College London Great Ormond Street Institute of Child Health, London, UK.,Departments of Neurology (A.P., A.K.S.S., R.S., M.A.K.)
| | - S Sudhakar
- Neuroradiology (K.M., S.S.), Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, UK
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Harada T, Kudo K, Fujima N, Yoshikawa M, Ikebe Y, Sato R, Shirai T, Bito Y, Uwano I, Miyata M. Quantitative Susceptibility Mapping: Basic Methods and Clinical Applications. Radiographics 2022; 42:1161-1176. [PMID: 35522577 DOI: 10.1148/rg.210054] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Quantitative susceptibility mapping (QSM), one of the advanced MRI techniques for evaluating magnetic susceptibility, offers precise quantitative measurements of spatial distributions of magnetic susceptibility. Magnetic susceptibility describes the magnetizability of a material to an applied magnetic field and is a substance-specific value. Recently, QSM has been widely used to estimate various levels of substances in the brain, including iron, hemosiderin, and deoxyhemoglobin (paramagnetism), as well as calcification (diamagnetism). By visualizing iron distribution in the brain, it is possible to identify anatomic structures that are not evident on conventional images and to evaluate various neurodegenerative diseases. It has been challenging to apply QSM in areas outside the brain because of motion artifacts from respiration and heartbeats, as well as the presence of fat, which has a different frequency to the proton. In this review, the authors provide a brief overview of the theoretical background and analyze methods of converting MRI phase images to QSM. Moreover, we provide an overview of the current clinical applications of QSM. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Taisuke Harada
- From the Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo, Japan (T.H., K.K., M.Y.); Center for Cause of Death Investigation (T.H.) and Global Center for Biomedical Science and Engineering (K.K.), Faculty of Medicine, Hokkaido University, Sapporo, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (T.H., K.K., N.F., M.Y., Y.I.); Innovative Technology Laboratory, Fujifilm Healthcare Corporation, Tokyo, Japan (R.S., T.S.); Fujifilm Healthcare Corporation, Chiba, Japan (Y.B.); Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan (I.U.); and Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba, Japan (M.M.)
| | - Kohsuke Kudo
- From the Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo, Japan (T.H., K.K., M.Y.); Center for Cause of Death Investigation (T.H.) and Global Center for Biomedical Science and Engineering (K.K.), Faculty of Medicine, Hokkaido University, Sapporo, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (T.H., K.K., N.F., M.Y., Y.I.); Innovative Technology Laboratory, Fujifilm Healthcare Corporation, Tokyo, Japan (R.S., T.S.); Fujifilm Healthcare Corporation, Chiba, Japan (Y.B.); Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan (I.U.); and Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba, Japan (M.M.)
| | - Noriyuki Fujima
- From the Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo, Japan (T.H., K.K., M.Y.); Center for Cause of Death Investigation (T.H.) and Global Center for Biomedical Science and Engineering (K.K.), Faculty of Medicine, Hokkaido University, Sapporo, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (T.H., K.K., N.F., M.Y., Y.I.); Innovative Technology Laboratory, Fujifilm Healthcare Corporation, Tokyo, Japan (R.S., T.S.); Fujifilm Healthcare Corporation, Chiba, Japan (Y.B.); Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan (I.U.); and Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba, Japan (M.M.)
| | - Masato Yoshikawa
- From the Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo, Japan (T.H., K.K., M.Y.); Center for Cause of Death Investigation (T.H.) and Global Center for Biomedical Science and Engineering (K.K.), Faculty of Medicine, Hokkaido University, Sapporo, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (T.H., K.K., N.F., M.Y., Y.I.); Innovative Technology Laboratory, Fujifilm Healthcare Corporation, Tokyo, Japan (R.S., T.S.); Fujifilm Healthcare Corporation, Chiba, Japan (Y.B.); Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan (I.U.); and Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba, Japan (M.M.)
| | - Yohei Ikebe
- From the Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo, Japan (T.H., K.K., M.Y.); Center for Cause of Death Investigation (T.H.) and Global Center for Biomedical Science and Engineering (K.K.), Faculty of Medicine, Hokkaido University, Sapporo, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (T.H., K.K., N.F., M.Y., Y.I.); Innovative Technology Laboratory, Fujifilm Healthcare Corporation, Tokyo, Japan (R.S., T.S.); Fujifilm Healthcare Corporation, Chiba, Japan (Y.B.); Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan (I.U.); and Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba, Japan (M.M.)
| | - Ryota Sato
- From the Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo, Japan (T.H., K.K., M.Y.); Center for Cause of Death Investigation (T.H.) and Global Center for Biomedical Science and Engineering (K.K.), Faculty of Medicine, Hokkaido University, Sapporo, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (T.H., K.K., N.F., M.Y., Y.I.); Innovative Technology Laboratory, Fujifilm Healthcare Corporation, Tokyo, Japan (R.S., T.S.); Fujifilm Healthcare Corporation, Chiba, Japan (Y.B.); Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan (I.U.); and Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba, Japan (M.M.)
| | - Toru Shirai
- From the Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo, Japan (T.H., K.K., M.Y.); Center for Cause of Death Investigation (T.H.) and Global Center for Biomedical Science and Engineering (K.K.), Faculty of Medicine, Hokkaido University, Sapporo, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (T.H., K.K., N.F., M.Y., Y.I.); Innovative Technology Laboratory, Fujifilm Healthcare Corporation, Tokyo, Japan (R.S., T.S.); Fujifilm Healthcare Corporation, Chiba, Japan (Y.B.); Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan (I.U.); and Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba, Japan (M.M.)
| | - Yoshitaka Bito
- From the Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo, Japan (T.H., K.K., M.Y.); Center for Cause of Death Investigation (T.H.) and Global Center for Biomedical Science and Engineering (K.K.), Faculty of Medicine, Hokkaido University, Sapporo, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (T.H., K.K., N.F., M.Y., Y.I.); Innovative Technology Laboratory, Fujifilm Healthcare Corporation, Tokyo, Japan (R.S., T.S.); Fujifilm Healthcare Corporation, Chiba, Japan (Y.B.); Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan (I.U.); and Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba, Japan (M.M.)
| | - Ikuko Uwano
- From the Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo, Japan (T.H., K.K., M.Y.); Center for Cause of Death Investigation (T.H.) and Global Center for Biomedical Science and Engineering (K.K.), Faculty of Medicine, Hokkaido University, Sapporo, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (T.H., K.K., N.F., M.Y., Y.I.); Innovative Technology Laboratory, Fujifilm Healthcare Corporation, Tokyo, Japan (R.S., T.S.); Fujifilm Healthcare Corporation, Chiba, Japan (Y.B.); Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan (I.U.); and Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba, Japan (M.M.)
| | - Mari Miyata
- From the Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo, Japan (T.H., K.K., M.Y.); Center for Cause of Death Investigation (T.H.) and Global Center for Biomedical Science and Engineering (K.K.), Faculty of Medicine, Hokkaido University, Sapporo, Japan; Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan (T.H., K.K., N.F., M.Y., Y.I.); Innovative Technology Laboratory, Fujifilm Healthcare Corporation, Tokyo, Japan (R.S., T.S.); Fujifilm Healthcare Corporation, Chiba, Japan (Y.B.); Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan (I.U.); and Department of Functional Brain Imaging, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology, Chiba, Japan (M.M.)
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Wilson JL, Gregory A, Kurian MA, Bushlin I, Mochel F, Emrick L, Adang L, Hogarth P, Hayflick SJ. Consensus clinical management guideline for beta-propeller protein-associated neurodegeneration. Dev Med Child Neurol 2021; 63:1402-1409. [PMID: 34347296 DOI: 10.1111/dmcn.14980] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 12/17/2022]
Abstract
This review provides recommendations for the evaluation and management of individuals with beta-propeller protein-associated neurodegeneration (BPAN). BPAN is one of several neurodegenerative disorders with brain iron accumulation along with pantothenate kinase-associated neurodegeneration, PLA2G6-associated neurodegeneration, mitochondrial membrane protein-associated neurodegeneration, fatty acid hydroxylase-associated neurodegeneration, and COASY protein-associated neurodegeneration. BPAN typically presents with global developmental delay and epilepsy in childhood, which is followed by the onset of dystonia and parkinsonism in mid-adolescence or adulthood. BPAN is an X-linked dominant disorder caused by pathogenic variants in WDR45, resulting in a broad clinical phenotype and imaging spectrum. This review, informed by an evaluation of the literature and expert opinion, discusses the clinical phenotype and progression of the disease, imaging findings, epilepsy features, and genetics, and proposes an approach to the initial evaluation and management of disease manifestations across the life span in individuals with BPAN. What this paper adds The complex epilepsy profile of beta-propeller protein-associated neurodegeneration (BPAN) often resolves in adolescence. The treatment for an individual with BPAN is supportive, with attention to sleep disorders, complex epilepsy, and behavioral problems. Individuals with BPAN have shifting needs throughout their life span requiring multidisciplinary care.
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Affiliation(s)
- Jenny L Wilson
- Division of Pediatric Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Allison Gregory
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Manju A Kurian
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL Institute of Child Health, London, UK
| | - Ittai Bushlin
- Division of Pediatric Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Fanny Mochel
- Department of Genetics, Reference Center for Neurometabolic Diseases, Assistance Publique-Hôpitaux de Paris, University Hospital La Pitié Salpêtrière, Paris, France
| | - Lisa Emrick
- Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Department of Human and Molecular Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Laura Adang
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Penelope Hogarth
- Departments of Molecular and Medical Genetics and Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Susan J Hayflick
- Departments of Molecular and Medical Genetics, Pediatrics, and Neurology, Oregon Health & Science University, Portland, OR, USA
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