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Abstract
Tuberous sclerosis complex (TSC) is a relatively rare autosomal dominant neurocutaneous disorder secondary to mutations in the TSC1 or TSC2 tumor suppressor genes. Although manifestation of the classic triad of seizures, intellectual disability, and facial angiofibromas may facilitate timely diagnosis of TSC, the multisystem features that may indicate TSC in the absence of these manifestations remain highly variable. In addition, patients with TSC are at risk of developing multiple benign and malignant tumors in various organ systems, resulting in increased morbidity and mortality. Thus, imaging plays a critical role in diagnosis, surveillance, and management of patients with TSC. It is crucial that radiologists be familiar with TSC and the various associated imaging features to avoid a delayed or incorrect diagnosis. Key manifestations include cortical dysplasias, subependymal nodules, subependymal giant cell astrocytomas, cardiac rhabdomyomas, lymphangioleiomyomatosis, and angiomyolipomas. Renal angiomyolipomas in particular can manifest with imaging features that mimic renal malignancy and pose a diagnostic dilemma. Other manifestations include dermatologic and ophthalmic manifestations, renal cysts, renal cell carcinomas, multifocal micronodular pneumocyte hyperplasia, splenic hamartomas, and other rare tumors such as perivascular epithelioid tumors. In addition to using imaging and clinical features to confirm the diagnosis, genetic testing can be performed. In this article, the molecular pathogenesis, clinical manifestations, and imaging features of TSC are reviewed. Current recommendations for management and surveillance of TSC are discussed as well. ©RSNA, 2021.
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Affiliation(s)
- Mindy X Wang
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Nicole Segaran
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Sanjeev Bhalla
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Perry J Pickhardt
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Meghan G Lubner
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Venkata S Katabathina
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
| | - Dhakshinamoorthy Ganeshan
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Unit 1473, Houston, TX 77030-4009 (M.X.W., D.G.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (N.S.); Mallinckrodt Institute of Radiology, Section of Abdominal Imaging, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P., M.G.L.); and Department of Radiology, University of Texas at San Antonio, San Antonio, Tex (V.S.K.)
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Tresoldi S, Munari A, Di Leo G, Pompili G, Magistrelli P, Secchi F, La Briola F, Canevini MP, Cornalba G, Sardanelli F. Myocardial Fatty Foci in Adult Patients with Tuberous Sclerosis Complex: Association with Gene Mutation and Multiorgan Involvement. Radiology 2015; 277:398-405. [PMID: 26069922 DOI: 10.1148/radiol.2015141890] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To estimate the association between myocardial fatty foci (MFF) on chest computed tomographic (CT) images and type of gene mutation or multiorgan involvement in patients with tuberous sclerosis complex (TSC). MATERIALS AND METHODS This retrospective case-control study was approved by the ethics committee, which waived the need for patient consent. Forty-eight patients with definite TSC (41 women; mean age, 35 years ± 11 [standard deviation]) and 96 age- and sex-matched patients without TSC who had undergone chest CT were evaluated. Two blinded readers independently scored MFF as low-attenuation areas within the myocardium. Patient history, gene mutation, and multiorgan involvement were obtained from clinical records. Cohen κ, Mann-Whitney U, χ(2) or Fisher exact, Kruskal-Wallis, and Spearman statistics were calculated. RESULTS One or more MFF was detected in 50% (24 of 48) of patients with TSC; however, no MFF was detected in control patients (P < .001). MFFs were oval (62%, 15 of 24) or linear (38%, nine of 24) and involved the left ventricle in 13 patients and both ventricles in 24 patients (mostly the apical or midleft ventricle); median size was 127 mm(2). After four patients with TSC and unknown mutational status (two with MFF) were excluded, MFF was detected in 53% (10 of 19) of patients with TSC1 mutation, 65% (11 of 17) of patients with TSC2 mutation, and 12% (one of eight) of patients with TSC but without an identified mutation (P = .044). MFF presence was associated with brain (P = .011) and multiorgan (P = .008) involvement. The number of MFF per patient correlated with the degree of multiorgan involvement (P = .014). With MFF considered predictive of TSC, 50% (24of 48) sensitivity, 100% (96 of 96) specificity, 100% (24 of 24) positive predictive value, and 80% (96 of 120) negative predictive value were obtained. CONCLUSION MFF was highly specific for TSC. MFF presence was associated with TSC gene mutations and with brain or multiorgan involvement; their number per patient was correlated with the degree of multiorgan involvement.
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Affiliation(s)
- Silvia Tresoldi
- From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli)
| | - Alice Munari
- From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli)
| | - Giovanni Di Leo
- From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli)
| | - Giovanni Pompili
- From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli)
| | - Paolo Magistrelli
- From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli)
| | - Francesco Secchi
- From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli)
| | - Francesca La Briola
- From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli)
| | - Maria Paola Canevini
- From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli)
| | - Gianpaolo Cornalba
- From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli)
| | - Francesco Sardanelli
- From the Diagnostic and Interventional Radiology Unit, Department of Diagnostic Services, Azienda Ospedaliera San Paolo, Via A. di Rudinì 8, 20142 Milan, Italy (S.T., G.P., G.C.); Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy (A.M., P.M.); Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy (G.D.L., F. Secchi, F. Sardanelli); Epilepsy Center, Azienda Ospedaliera San Paolo, Milan, Italy (F.L.B., M.P.C.); Department of Health Sciences, Università degli Studi di Milano, Milan, Italy (M.P.C., G.C.); and Department of Biomedical Sciences for Health, Università degli Studi di Milano, San Donato Milanese, Italy (F. Sardanelli)
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