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de Blank P, Nishiyama A, López-Juárez A. A new era for myelin research in Neurofibromatosis type 1. Glia 2023; 71:2701-2719. [PMID: 37382486 PMCID: PMC10592420 DOI: 10.1002/glia.24432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023]
Abstract
Evidence for myelin regulating higher-order brain function and disease is rapidly accumulating; however, defining cellular/molecular mechanisms remains challenging partially due to the dynamic brain physiology involving deep changes during development, aging, and in response to learning and disease. Furthermore, as the etiology of most neurological conditions remains obscure, most research models focus on mimicking symptoms, which limits understanding of their molecular onset and progression. Studying diseases caused by single gene mutations represents an opportunity to understand brain dys/function, including those regulated by myelin. Here, we discuss known and potential repercussions of abnormal central myelin on the neuropathophysiology of Neurofibromatosis Type 1 (NF1). Most patients with this monogenic disease present with neurological symptoms diverse in kind, severity, and onset/decline, including learning disabilities, autism spectrum disorders, attention deficit and hyperactivity disorder, motor coordination issues, and increased risk for depression and dementia. Coincidentally, most NF1 patients show diverse white matter/myelin abnormalities. Although myelin-behavior links were proposed decades ago, no solid data can prove or refute this idea yet. A recent upsurge in myelin biology understanding and research/therapeutic tools provides opportunities to address this debate. As precision medicine moves forward, an integrative understanding of all cell types disrupted in neurological conditions becomes a priority. Hence, this review aims to serve as a bridge between fundamental cellular/molecular myelin biology and clinical research in NF1.
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Affiliation(s)
- Peter de Blank
- Department of Pediatrics, The Cure Starts Now Brain Tumor Center, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Akiko Nishiyama
- Department of Physiology and Neurobiology, University of Connecticut, Storrs, Connecticut, USA
| | - Alejandro López-Juárez
- Department of Health and Biomedical Sciences, University of Texas Rio Grande Valley, Brownsville, Texas, USA
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Anders R, Hirsch FW, Roth C. [Neurofibromatosis type 1 : From diagnosis to follow-up]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:1050-1057. [PMID: 36070094 DOI: 10.1007/s00117-022-01059-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a tumor predisposition syndrome and is one of the most common genetic diseases. It is therefore a condition encountered by radiologists in clinical routine. Since the variability of the clinical expression is very high and several organ systems are affected, we present a standardized diagnostic approach in this article. METHODS Evaluation of the literature on neurofibromatosis type 1 in the context of radiological examination methods. RESULTS In addition to the frequently known changes in the central and peripheral nervous system such as optic gliomas and plexiform neurofibromas, lesions from the orthopedic spectrum and vascular changes must also be included in the radiological diagnosis. CONCLUSIONS Due to the diversity of the clinical picture of NF1, it is reasonable to define an examination strategy which takes into account the needs of radiological routine and also reliably detects the most frequent and prognostically significant pathologies accompanying this disease. In this article, the current recommendations for diagnosis of neurofibromatosis-associated tumors and skeletal changes are summarized, and examination protocols and time intervals are suggested.
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Affiliation(s)
- Rebecca Anders
- Institut für Kinderradiologie, Universitätsklinikum Leipzig, Liebigstr. 20a, 04103, Leipzig, Deutschland
| | - Franz Wolfgang Hirsch
- Institut für Kinderradiologie, Universitätsklinikum Leipzig, Liebigstr. 20a, 04103, Leipzig, Deutschland
| | - Christian Roth
- Institut für Kinderradiologie, Universitätsklinikum Leipzig, Liebigstr. 20a, 04103, Leipzig, Deutschland.
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Familial Neoplastic Syndromes. Neurol Clin 2022; 40:405-420. [DOI: 10.1016/j.ncl.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wang S, Mautner VF, Buchert R, Flibotte S, Suppa P, Friedman JM, Heran MKS. Alterations in brain morphology by MRI in adults with neurofibromatosis 1. Orphanet J Rare Dis 2021; 16:462. [PMID: 34727946 PMCID: PMC8561988 DOI: 10.1186/s13023-021-02097-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/24/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Neurofibromatosis 1 (NF1) is a rare autosomal dominant disease that causes the dysregulated growth of Schwann cells. Most reported studies of brain morphology in NF1 patients have included only children, and clinical implications of the observed changes later in life remain unclear. In this study, we used MRI to characterize brain morphology in adults with NF1. METHODS Planar (2D) MRI measurements of 29 intracranial structures were compared in 389 adults with NF1 and 112 age- and sex-matched unaffected control subjects. The 2D measurements were correlated with volumetric (3D) brain measurements in 99 of the adults with NF1 to help interpret the 2D findings. A subset (n = 70) of these NF1 patients also received psychometric testing for attention deficits and IQ and was assessed for clinical severity of NF1 features and neurological problems. Correlation analysis was performed between the MRI measurements and clinical and psychometric features of these patients. RESULTS Four of nine corpus callosum measurements were significantly greater in adults with NF1 than in sex- and age-matched controls. All seven brainstem measurements were significantly greater in adults with NF1 than in controls. Increased corpus callosum and brainstem 2D morphology were correlated with increased total white matter volume among the NF1 patients. No robust correlations were observed between the 2D size of these structures and clinical or neuropsychometric assessments. CONCLUSION Our findings are consistent with the hypothesis that dysregulation of brain myelin production is an important manifestation of NF1 in adults.
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Affiliation(s)
- Su Wang
- Department of Medical Genetics, University of British Columbia, Children's and Women's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Victor-Felix Mautner
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Buchert
- Department of Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stephane Flibotte
- UBC/LSI Bioinformatics Facility, University of British Columbia, Vancouver, BC, Canada
| | - Per Suppa
- Department of Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, Children's and Women's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Manraj K S Heran
- Diagnostic and Therapeutic Neuroradiology, University of British Columbia, Vancouver, Canada
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Coban G, Parlak S, Gumeler E, Altunbuker H, Konuşkan B, Karakaya J, Anlar B, Oguz KK. Synthetic MRI in Neurofibromatosis Type 1. AJNR Am J Neuroradiol 2021; 42:1709-1715. [PMID: 34266869 DOI: 10.3174/ajnr.a7214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/19/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Synthetic MRI enables the generation of various contrast-weighted images and quantitative data in a reasonable scanning time. We aimed to use synthetic MRI to assess the detection and underlying tissue characteristics of focal areas of signal intensity and normal-appearing brain parenchyma and morphometric alterations in the brains of patients with neurofibromatosis type 1. MATERIALS AND METHODS Conventional MR imaging and synthetic MRI were prospectively obtained from 19 patients with neurofibromatosis type 1 and 18 healthy controls. Two neuroradiologists independently evaluated focal areas of signal intensity on both conventional MR imaging and synthetic MRI. Additionally, automatically segmented volume calculations of the brain in both groups and quantitative analysis of myelin, including the focal areas of signal intensity and normal-appearing brain parenchyma, of patients with neurofibromatosis type 1 were performed using synthetic MRI. RESULTS The comparison of conventional MR imaging and synthetic MRI showed good correlation in the supratentorial region of the brain (κ = 0.82-1). Automatically segmented brain parenchymal volume, intracranial volume, and GM volumes were significantly increased in the patients with neurofibromatosis type 1 (P < .05). The myelin-correlated compound, myelin fraction volume, WM fraction volume, transverse relaxation rate, and longitudinal relaxation rate values were significantly decreased in focal areas of signal intensity on myelin and WM maps (P < .001); however, GM, GM fraction volume, and proton density values were significantly increased on the GM map (P < .001). CONCLUSIONS Synthetic MRI is a potential tool for the assessment of morphometric and tissue alterations as well as the detection of focal areas of signal intensity in patients with neurofibromatosis type 1 in a reasonable scan time.
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Affiliation(s)
- G Coban
- From the Departments of Radiology (G.C., S.P., E.G., K.K.O.)
| | - S Parlak
- From the Departments of Radiology (G.C., S.P., E.G., K.K.O.)
| | - E Gumeler
- From the Departments of Radiology (G.C., S.P., E.G., K.K.O.)
| | - H Altunbuker
- Istanbul Il Ambulans Servisi Başhekimliği, (H.A.), Istanbul, Turkey
| | - B Konuşkan
- Department of Pediatric Neurology (B.K.), Mardin State Hospital, Mardin, Turkey
| | | | - B Anlar
- Pediatric Neurology (B.A.), Hacettepe University School of Medicine, Ankara, Turkey
| | - K K Oguz
- From the Departments of Radiology (G.C., S.P., E.G., K.K.O.)
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Importance of Thalamostriatal Pathway Associated With Neurocognitive Dysfunctions in Children With Neurofibromatosis Type 1: Diffusion Tensor Imaging Findings. J Comput Assist Tomogr 2021; 45:294-299. [PMID: 33661154 DOI: 10.1097/rct.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether there is a difference between healthy control group and children with neurofibromatosis type 1 (NF1) in terms of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values in different regions of the brain associated with neurocognitive functions and to investigate the correlation between diffusion tensor imaging parameters and neurocognitive dysfunctions. METHODS The study included 28 children with NF1 and 21 controls. Nine distinct areas related to cognitive functions were selected for the analysis. The ADC and FA values were compared. RESULTS There was a significant difference between NF1 and healthy control in terms of ADC values obtained from all areas. The ADC values at obtained from thalamus and striatum were positively correlated with the full-scale intelligence quotient (IQ), verbal IQ, and performance IQ. CONCLUSIONS We are speculated that the development of microstructural damage in the thalamostriatal pathway may lead to neurocognitive dysfunction.
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Hainc N, Wagner MW, Laughlin S, Rutka J, Hawkins C, Blaser S, Ertl-Wagner BB. Longitudinal Assessment of Enhancing Foci of Abnormal Signal Intensity in Neurofibromatosis Type 1. AJNR Am J Neuroradiol 2021; 42:766-773. [PMID: 33541905 DOI: 10.3174/ajnr.a6974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/23/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients with neurofibromatosis 1 are at increased risk of developing brain tumors, and differentiation from contrast-enhancing foci of abnormal signal intensity can be challenging. We aimed to longitudinally characterize rare, enhancing foci of abnormal signal intensity based on location and demographics. MATERIALS AND METHODS A total of 109 MR imaging datasets from 19 consecutive patients (7 male; mean age, 8.6 years; range, 2.3-16.8 years) with neurofibromatosis 1 and a total of 23 contrast-enhancing parenchymal lesions initially classified as foci of abnormal signal intensity were included. The mean follow-up period was 6.5 years (range, 1-13.8 years). Enhancing foci of abnormal signal intensity were followed up with respect to presence, location, and volume. Linear regression analysis was performed. RESULTS Location, mean peak volume, and decrease in enhancing volume over time of the 23 lesions were as follows: 10 splenium of the corpus callosum (295 mm3, 5 decreasing, 3 completely resolving, 2 surgical intervention for change in imaging appearance later confirmed to be gangliocytoma and astrocytoma WHO II), 1 body of the corpus callosum (44 mm3, decreasing), 2 frontal lobe white matter (32 mm3, 1 completely resolving), 3 globus pallidus (50 mm3, all completely resolving), 6 cerebellum (206 mm3, 3 decreasing, 1 completely resolving), and 1 midbrain (34 mm3). On average, splenium lesions began to decrease in size at 12.2 years, posterior fossa lesions at 17.1 years, and other locations at 9.4 years of age. CONCLUSIONS Albeit very rare, contrast-enhancing lesions in patients with neurofibromatosis 1 may regress over time. Follow-up MR imaging aids in ascertaining regression. The development of atypical features should prompt further evaluation for underlying tumors.
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Affiliation(s)
- N Hainc
- From the Department of Diagnostic Imaging (N.H., M.W.W., S.L., S.B., B.B.E.-W.), Division of Neuroradiology.,Department of Neuroradiology (N.H.), Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - M W Wagner
- From the Department of Diagnostic Imaging (N.H., M.W.W., S.L., S.B., B.B.E.-W.), Division of Neuroradiology
| | - S Laughlin
- From the Department of Diagnostic Imaging (N.H., M.W.W., S.L., S.B., B.B.E.-W.), Division of Neuroradiology
| | - J Rutka
- Department of Surgery, Division of Neurosurgery (J.R.)
| | - C Hawkins
- Department of Paediatric Laboratory Medicine (C.H.), The Hospital for Sick Children and Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada
| | - S Blaser
- From the Department of Diagnostic Imaging (N.H., M.W.W., S.L., S.B., B.B.E.-W.), Division of Neuroradiology
| | - B B Ertl-Wagner
- From the Department of Diagnostic Imaging (N.H., M.W.W., S.L., S.B., B.B.E.-W.), Division of Neuroradiology
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Calvez S, Levy R, Calvez R, Roux CJ, Grévent D, Purcell Y, Beccaria K, Blauwblomme T, Grill J, Dufour C, Bourdeaut F, Doz F, Robert MP, Boddaert N, Dangouloff-Ros V. Focal Areas of High Signal Intensity in Children with Neurofibromatosis Type 1: Expected Evolution on MRI. AJNR Am J Neuroradiol 2020; 41:1733-1739. [PMID: 32816766 DOI: 10.3174/ajnr.a6740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/07/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Focal areas of high signal intensity are T2WI/T2-FLAIR hyperintensities frequently found on MR imaging of children diagnosed with neurofibromatosis type 1, often thought to regress spontaneously during adolescence or puberty. Due to the risk of tumor in this population, some focal areas of high signal intensity may pose diagnostic problems. The objective of this study was to assess the characteristics and temporal evolution of focal areas of high signal intensity in children with neurofibromatosis type 1 using long-term follow-up with MR imaging. MATERIALS AND METHODS We retrospectively examined the MRIs of children diagnosed with neurofibromatosis type 1 using the National Institutes of Health Consensus Criteria (1987), with imaging follow-up of at least 4 years. We recorded the number, size, and surface area of focal areas of high signal intensity according to their anatomic distribution on T2WI/T2-FLAIR sequences. A generalized mixed model was used to analyze the evolution of focal areas of high signal intensity according to age, and separate analyses were performed for girls and boys. RESULTS Thirty-nine patients (ie, 285 MR images) with a median follow-up of 7 years were analyzed. Focal areas of high signal intensity were found in 100% of patients, preferentially in the infratentorial white matter (35% cerebellum, 30% brain stem) and in the capsular lenticular region (22%). They measured 15 mm in 95% of cases. They appeared from the age of 1 year; increased in number, size, and surface area to a peak at the age of 7; and then spontaneously regressed by 17 years of age, similarly in girls and boys. CONCLUSIONS Focal areas of high signal intensity are mostly small (<15 mm) abnormalities in the posterior fossa or capsular lenticular region. Our results suggest that the evolution of focal areas of high signal intensity is not related to puberty with a peak at the age of 7 years. Knowledge of the predictive evolution of focal areas of high signal intensity is essential in the follow-up of children with neurofibromatosis type 1.
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Affiliation(s)
- S Calvez
- From the Pediatric Radiology Department (S.C., R.L., C.-J.R., D.G., N.B., V.D.-R.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - R Levy
- From the Pediatric Radiology Department (S.C., R.L., C.-J.R., D.G., N.B., V.D.-R.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale U1000, (R.L., C.-J.R., D.G., N.B., V.D.-R.), Paris, France
- Institut Imagine (R.L., C.-J.R., D.G., N.B., V.D.-.R.), Unite Mixte de Recherche 1163, Paris, France
| | - R Calvez
- Expert Biostatistician (R.C.), Gagny, France
| | - C-J Roux
- From the Pediatric Radiology Department (S.C., R.L., C.-J.R., D.G., N.B., V.D.-R.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale U1000, (R.L., C.-J.R., D.G., N.B., V.D.-R.), Paris, France
- Institut Imagine (R.L., C.-J.R., D.G., N.B., V.D.-.R.), Unite Mixte de Recherche 1163, Paris, France
| | - D Grévent
- From the Pediatric Radiology Department (S.C., R.L., C.-J.R., D.G., N.B., V.D.-R.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale U1000, (R.L., C.-J.R., D.G., N.B., V.D.-R.), Paris, France
- Institut Imagine (R.L., C.-J.R., D.G., N.B., V.D.-.R.), Unite Mixte de Recherche 1163, Paris, France
| | - Y Purcell
- Radiology Department (Y.P.), Fondation Rothschild, Paris, France
| | - K Beccaria
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Pediatric Neurosurgery Department (K.B., T.B.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T Blauwblomme
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Pediatric Neurosurgery Department (K.B., T.B.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - J Grill
- Department of Pediatric and Adolescent Oncology (J.G., C.D.), Gustave Roussy Institute, Villejuif, France
| | - C Dufour
- Department of Pediatric and Adolescent Oncology (J.G., C.D.), Gustave Roussy Institute, Villejuif, France
| | - F Bourdeaut
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Oncology Center SIREDO (Care Innovation and Research for Children, Adolescents and Young Adults with Cancer) (F.B., F.D.), Institute Curie, ???????, France
| | - F Doz
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
| | - M P Robert
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Ophthalmology Department (M.P.R.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - N Boddaert
- From the Pediatric Radiology Department (S.C., R.L., C.-J.R., D.G., N.B., V.D.-R.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale U1000, (R.L., C.-J.R., D.G., N.B., V.D.-R.), Paris, France
- Institut Imagine (R.L., C.-J.R., D.G., N.B., V.D.-.R.), Unite Mixte de Recherche 1163, Paris, France
| | - V Dangouloff-Ros
- From the Pediatric Radiology Department (S.C., R.L., C.-J.R., D.G., N.B., V.D.-R.), Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris University (R.L., C.-J.R., D.G., K.B., T.B., F.B., F.D., M.P.R., N.B., V.D.-R.), PRES Sorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale U1000, (R.L., C.-J.R., D.G., N.B., V.D.-R.), Paris, France
- Institut Imagine (R.L., C.-J.R., D.G., N.B., V.D.-.R.), Unite Mixte de Recherche 1163, Paris, France
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Murphy C, Vassallo G, Burkitt-Wright E, Hupton E, Eelloo J, Lewis L, Huson S, Stivaros S, Kamaly-Asl I. A retrospective regional study of aqueduct stenosis and fourth ventricle outflow obstruction in the paediatric complex neurofibromatosis type 1 population; Aetiology, clinical presentation and management. Clin Neurol Neurosurg 2020; 193:105791. [PMID: 32208299 DOI: 10.1016/j.clineuro.2020.105791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Aqueduct stenosis (AS) and fourth ventricle outflow obstruction are rare associations of neurofibromatosis type 1 (NF1), resulting in ventriculomegaly and hydrocephalus requiring surgical treatment. This study aims to identify the prevalence of AS and its patterns of clinical presentation, aetiology and treatment in the paediatric complex NF1 population. PATIENTS AND METHODS Patients with NF-1 aged 0-18 years were recruited from the Regional Genetic Family Register, following institutional review board approval. Magnetic resonance imaging data and clinical documents were reviewed with respect to clinical presentation, degree of ventriculomegaly, aetiological factors and management of AS and fourth ventricle outflow obstruction. RESULTS 24 of the 233 paediatric patients seen within the NHS highly specialised service for complex NF1 were found to have AS or and fourth ventricle outflow obstruction. This included 13 males and 11 females with a mean age of 9 years 5 months (range 8 months - 17 years). The majority of patients with AS or fourth ventricle outflow obstruction presented with symptoms of raised intracranial pressure associated with ventriculomegaly and/or hydrocephalus (n = 18). However, in 25 % of patients, AS was an incidental finding on MRI and was observed both in the presence (n = 2) and absence (n = 4) of ventriculomegaly. In the majority of cases a single cause of AS was identified (n = 16), of which tectal plate thickening (n = 7) was most frequently observed. The remaining 8 patients had multiple causes of AS, in which tectal plate thickening (n = 7) and aqueductal webs (n = 5) were the most common observations. Surgery was performed on all patients with evidence of raised pressure (n = 8) by performing endoscopic third ventriculostomy (ETV) (n = 5) or ventriculoperitoneal (VP)-shunting (n = 3). Tectal plate thickening was most frequently observed in patients who underwent ETV (n = 3), followed by aqueductal web (n = 1) and T2-signal changes in the tectal plate (n = 1). Patients treated with VP-shunt had 4th ventricle outflow obstruction (n = 2) and a tectal plate tumour (n = 1). CONCLUSION This study identifies that AS is more prevalent amongst the paediatric complex NF-1 population than previously reported, occurring in 10 % of cases. Our findings demonstrate that AS is most commonly symptomatic in presentation but can be asymptomatic in 25 % of paediatric complex NF1 patients. In this population, AS can occur both in the presence and absence of ventriculomegaly and therefore requires careful monitoring for development of hydrocephalus. In this study, over one third of patients (9 of 24 patients) with AS eventually required treatment.
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Affiliation(s)
- Christopher Murphy
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom,; Department of Pediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, M13 9WL, UK.
| | - Grace Vassallo
- Nationally Comissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Emma Burkitt-Wright
- Nationally Comissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Eileen Hupton
- Nationally Comissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Judith Eelloo
- Nationally Comissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Lauren Lewis
- Nationally Comissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Susan Huson
- Nationally Comissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Stavros Stivaros
- Nationally Comissioned Complex NF1 Service, Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK; Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom; Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Ian Kamaly-Asl
- Department of Pediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, M13 9WL, UK
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Clinical Management of Children and Adolescents with Neurofibromatosis Type 1 Like Phenotypes and Complex Behavioural Manifestations: A Multidisciplinary and Dimensional Approach. Case Rep Psychiatry 2020; 2019:4764031. [PMID: 32089936 PMCID: PMC7011498 DOI: 10.1155/2019/4764031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 11/27/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction. Cognitive and behavioural problems associated with Neurofibromatosis type 1 (NF1) are common sources of distress and the reasons behind seeking help. Here we describe patients with NF1 or NF1-like phenotypes referred to a Tier 3 Child and Adolescent Psychiatry Department and highlight the benefits of a multidisciplinary assessment.
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11
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Haebich KM, Pride NA, Walsh KS, Chisholm A, Rouel M, Maier A, Anderson V, Barton B, Silk T, Korgaonkar M, Seal M, Lami F, Lorenzo J, Williams K, Dabscheck G, Rae CD, Kean M, North KN, Payne JM. Understanding autism spectrum disorder and social functioning in children with neurofibromatosis type 1: protocol for a cross-sectional multimodal study. BMJ Open 2019; 9:e030601. [PMID: 31558455 PMCID: PMC6773330 DOI: 10.1136/bmjopen-2019-030601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Children with the single-gene disorder neurofibromatosis type 1 (NF1) appear to be at an increased risk for autism spectrum disorder (ASD) and exhibit a unique social-cognitive phenotype compared with children with idiopathic ASD. A complete framework is required to better understand autism in NF1, from neurobiological levels through to behavioural and functional outcomes. The primary aims of this study are to establish the frequency of ASD in children with NF1, examine the social cognitive phenotype, investigate the neuropsychological processes contributing to ASD symptoms and poor social functioning in children with NF1, and to investigate novel structural and functional neurobiological markers of ASD and social dysfunction in NF1. The secondary aim of this study is to compare the neuropsychological and neurobiological features of ASD in children with NF1 to a matched group of patients with idiopathic ASD. METHODS AND ANALYSIS This is an international, multisite, prospective, cross-sectional cohort study of children with NF1, idiopathic ASD and typically developing (TD) controls. Participants will be 200 children with NF1 (3-15 years of age), 70 TD participants (3-15 years) and 35 children with idiopathic ASD (7-15 years). Idiopathic ASD and NF1 cases will be matched on age, sex and intelligence. All participants will complete cognitive testing and parents will rate their child's behaviour on standardised questionnaires. Neuroimaging will be completed by a subset of participants aged 7 years and older. Children with NF1 that screen at risk for ASD on the parent-rated Social Responsiveness Scale 2nd Edition will be invited back to complete the Autism Diagnostic Observation Scale 2nd Edition and Autism Diagnostic Interview-Revised to determine whether they fulfil ASD diagnostic criteria. ETHICS AND DISSEMINATION This study has hospital ethics approval and the results will be disseminated through peer-reviewed publications and international conferences.
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Affiliation(s)
- Kristina M Haebich
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
| | - Natalie A Pride
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Westmead, NSW, Australia
| | - Karin S Walsh
- Center for Neuroscience and Behavioral Medicine, Children's National Health System, Washington, DC, United States
- Departments of Pediatrics and Psychiatry, The George Washington University School of Medicine, Washington, DC, United States
| | - Anita Chisholm
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
| | - Melissa Rouel
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Alice Maier
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Vicki Anderson
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
| | - Belinda Barton
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Westmead, NSW, Australia
- Children's Hospital Education Research Institute, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Tim Silk
- School of Psychology, Deakin University, Burwood, VIC, Australia
| | - Mayuresh Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
| | - Marc Seal
- Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Francesca Lami
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jennifer Lorenzo
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Gabriel Dabscheck
- Department of Neurology, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Caroline D Rae
- Neuroscience Research Australia, University of New South Wales, Randwick, NSW, Australia
| | - Michael Kean
- Imaging Department, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Kathryn N North
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jonathan M Payne
- Brain and Mind, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Parkville, VIC, Australia
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Nemmi F, Cignetti F, Assaiante C, Maziero S, Audic F, Péran P, Chaix Y. Discriminating between neurofibromatosis-1 and typically developing children by means of multimodal MRI and multivariate analyses. Hum Brain Mapp 2019; 40:3508-3521. [PMID: 31077476 DOI: 10.1002/hbm.24612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/08/2019] [Accepted: 04/17/2019] [Indexed: 11/08/2022] Open
Abstract
Neurofibromatosis Type 1 leads to brain anomalies involving both gray and white matter. The extent and granularity of these anomalies, together with their possible impact on brain activity, is still unknown. In this multicentric cross-sectional study we submitted a sample of 42 typically developing and 38 neurofibromatosis-1 children to a multimodal MRI assessment including T1, diffusion weighted and resting state functional sequences. We used a pipeline involving several features selection steps coupled with multivariate statistical analysis (supporting vector machine) to discriminate between the two groups while having interpretable models. We used MRI indexes measuring macro (gray matter volume) and microstructural (fractional anisotropy, mean diffusivity) characteristics of the brain, as well as indexes of brain activity (fractional amplitude of low frequency fluctuations) and connectivity (local and global correlation) at rest. We found that structural indexes could discriminate between the two groups, with the mean diffusivity leading to performance as high as the combination of all structural indexes combined (accuracy = 0.86), while functional indexes had worse performances. The MRI signature of NF1 brain pathology is a combination of gray and white matter abnormalities, as measured with gray matter volume, fractional anisotropy, and mean diffusivity.
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Affiliation(s)
- Federico Nemmi
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Fabien Cignetti
- CNRS, LNC, Aix Marseille Université, Marseille, France.,CNRS, Fédération 3C, Aix Marseille Université, Marseille, France.,CNRS, TIMC-IMAG, Université Grenoble Alpes, Grenoble, France
| | - Christine Assaiante
- CNRS, LNC, Aix Marseille Université, Marseille, France.,CNRS, Fédération 3C, Aix Marseille Université, Marseille, France
| | - Stephanie Maziero
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,URI Octogone-Lordat (EA 4156), Université de Toulouse, Toulouse, France
| | - Fredrique Audic
- Service de Neurologie Pédiatrique, CHU Timone-Enfants, Marseille, France
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Yves Chaix
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
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13
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Reinert CP, Schuhmann MU, Bender B, Gugel I, la Fougère C, Schäfer J, Gatidis S. Comprehensive anatomical and functional imaging in patients with type I neurofibromatosis using simultaneous FDG-PET/MRI. Eur J Nucl Med Mol Imaging 2018; 46:776-787. [DOI: 10.1007/s00259-018-4227-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/25/2018] [Indexed: 12/31/2022]
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14
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Salman MS, Hossain S, Alqublan L, Bunge M, Rozovsky K. Cerebellar radiological abnormalities in children with neurofibromatosis type 1: part 1 - clinical and neuroimaging findings. CEREBELLUM & ATAXIAS 2018; 5:14. [PMID: 30410779 PMCID: PMC6211433 DOI: 10.1186/s40673-018-0093-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/03/2018] [Indexed: 02/01/2023]
Abstract
Background Many children with neurofibromatosis type 1 (NF1) have focal abnormal signal intensities (FASI) on brain MRI, whose full clinical impact and natural history have not been studied systematically. Our aims are to describe the clinical and neuroradiological features in children with NF1 and cerebellar FASI, and report on the natural history of FASI that display atypical features such as enhancement and mass effect. Method A retrospective review of the hospital charts and brain MRIs was performed on children from Manitoba diagnosed between 1999 and 2008 with NF1, who also had cerebellar FASI on MRI. Results Fifty patients (mean age: 16.1y, minimum-maximum: 6.4 - 30y, 27 M) were identified. Mean duration of follow up was 10.1y. Developmental delay, learning disabilities, tumors, and visual signs occurred commonly. Cerebellar signs were not reported. Mean age of the patients at baseline MRI was 7.8 (SD: 4.5) years. FASI occurred in several brain locations and were rarely confined to the cerebellum. FASI displayed mass effect and enhancement infrequently but were associated with malignancy only once. The number of FASI at baseline MRI was significantly less in patients with attention deficient hyperactivity disorder and more if a first degree relative had NF1 or if they had decreased visual acuity. Discussion Patients with NF1 and cerebellar FASI do not have motor or consistent non-motor (e.g. developmental delay or learning disabilities) cerebellar features. The number of FASI may correlate with some clinical features. FASI may display enhancement and mass effect but they rarely become malignant.
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Affiliation(s)
- Michael S Salman
- 1Section of Pediatric Neurology, Winnipeg Children's Hospital and Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, AE 308, 820 Sherbrook Street, Winnipeg, MB R3A 1R9 Canada
| | - Shakhawat Hossain
- 2Department of Mathematics and Statistics, University of Winnipeg, Winnipeg, MB Canada
| | - Lina Alqublan
- 3Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada.,4Present Address: Department of Radiology, King Fahad Armed Forces Hospital, Jeddah, Western region Saudi Arabia
| | - Martin Bunge
- 5Section of Pediatric Radiology, Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Katya Rozovsky
- 5Section of Pediatric Radiology, Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
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15
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Salman MS, Hossain S, Gorun S, Alqublan L, Bunge M, Rozovsky K. Cerebellar radiological abnormalities in children with neurofibromatosis type 1: part 2 - a neuroimaging natural history study with clinical correlations. CEREBELLUM & ATAXIAS 2018; 5:13. [PMID: 30410778 PMCID: PMC6208104 DOI: 10.1186/s40673-018-0092-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/03/2018] [Indexed: 01/12/2023]
Abstract
Background Focal abnormal signal intensities (FASI) on brain MRI occur commonly in patients with neurofibromatosis type 1 (NF1). The natural history of cerebellar FASI and their correlation with clinical features have not been studied comprehensively. Our aims are to describe the natural history of cerebellar FASI on repeat MRI scans and correlate the findings with the clinical features in children with NF1 and cerebellar FASI. Method A retrospective review of 226 brain MRI scans and hospital charts was performed in 50 patients with cerebellar FASI, who were diagnosed with NF1 during their childhood between 1999 and 2008. Results Mean age at the end of the study period was 16.1 years. There were 27 males. Mean duration of clinical follow up was 10.1 years. Mean duration between the first and the last MRI was 6.6 years (n = 36, SD: 2.8 years). FASI were rarely confined to the cerebellum. The number of FASI was highest in early childhood and decreased significantly on subsequent MRI scans in most brain regions with the exception of the cerebrum, where a fewer number of patients with a smaller number of FASI were seen. Four patterns of change in FASI size over time were determined, none correlated with the clinical features. Conclusions In patients with NF1, the natural history of FASI including their number, age at onset, rate of size changes, and resolution if any, varies by brain region. FASI patterns of change over time showed no clinical correlate.
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Affiliation(s)
- Michael S Salman
- 1Section of Pediatric Neurology, Winnipeg Children's Hospital and Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, AE 308, 820 Sherbrook Street, Winnipeg, MB R3A 1R9 Canada
| | - Shakhawat Hossain
- 2Department of Mathematics and Statistics, University of Winnipeg, Winnipeg, MB Canada
| | - Samantha Gorun
- 2Department of Mathematics and Statistics, University of Winnipeg, Winnipeg, MB Canada
| | - Lina Alqublan
- 3Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada.,4Present Address: Department of Radiology, King Fahad Armed Forces Hospital, Jeddah, Western region Saudi Arabia
| | - Martin Bunge
- 5Section of Pediatric Radiology, Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
| | - Katya Rozovsky
- 5Section of Pediatric Radiology, Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB Canada
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16
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Barkovich MJ, Tan CH, Nillo RM, Li Y, Xu D, Glastonbury CM, Glenn OA, Dillon WP, Hess CP, Mueller S, Kline C, Dale AM, Jernigan TL, Sugrue LP, Barkovich AJ, Desikan RS. Abnormal Morphology of Select Cortical and Subcortical Regions in Neurofibromatosis Type 1. Radiology 2018; 289:499-508. [PMID: 30179114 DOI: 10.1148/radiol.2018172863] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate whether patients with neurofibromatosis type 1 (NF1)-a multisystem neurodevelopmental disorder with myriad imaging manifestations, including focal transient myelin vacuolization within the deep gray nuclei, brainstem, and cerebellum-exhibit differences in cortical and subcortical structures, particularly in subcortical regions where these abnormalities manifest. Materials and Methods In this retrospective study, by using clinically obtained three-dimensional T1-weighted MR images and established image analysis methods, 10 intracranial volume-corrected subcortical and 34 cortical regions of interest (ROIs) were quantitatively assessed in 32 patients with NF1 and 245 age- and sex-matched healthy control subjects. By using linear models, ROI cortical thicknesses and volumes were compared between patients with NF1 and control subjects, as a function of age. With hierarchic cluster analysis and partial correlations, differences in the pattern of association between cortical and subcortical ROI volumes in patients with NF1 and control subjects were also evaluated. Results Patients with NF1 exhibited larger subcortical volumes and thicker cortices of select regions, particularly the hippocampi, amygdalae, cerebellar white matter, ventral diencephalon, thalami, and occipital cortices. For the thalami and pallida and 22 cortical ROIs in patients with NF1, a significant inverse association between volume and age was found, suggesting that volumes decrease with increasing age. Moreover, compared with those in control subjects, ROIs in patients with NF1 exhibited a distinct pattern of clustering and partial correlations. Discussion Neurofibromatosis type 1 is characterized by larger subcortical volumes and thicker cortices of select structures. Most apparent within the hippocampi, amygdalae, cerebellar white matter, ventral diencephalon, thalami and occipital cortices, these neurofibromatosis type 1-associated volumetric changes may, in part, be age dependent. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Matthew J Barkovich
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - Chin Hong Tan
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - Ryan M Nillo
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - Yi Li
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - Duan Xu
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - Christine M Glastonbury
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - Orit A Glenn
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - William P Dillon
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - Christopher P Hess
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - Sabine Mueller
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - Cassie Kline
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - Anders M Dale
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - Terry L Jernigan
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - Leo P Sugrue
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - A James Barkovich
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
| | - Rahul S Desikan
- From the Departments of Radiology and Biomedical Imaging (M.J.B., C.H.T., R.M.N., Y.L., D.X., C.M.G., O.A.G., W.P.D., C.P.H., L.P.S., A.J.B., R.S.D.), Pediatrics (S.M., C.K., A.J.B., R.S.D.), and Neurology (S.M., C.K., R.S.D.), University of California, San Francisco, 505 Parnassus Ave, Room L352, San Francisco, CA 94143-0628; and Department of Cognitive Science (A.M.D., T.L.J.), Multimodal Imaging Laboratory (A.M.D.), and Department of Radiology (A.M.D., T.L.J.), University of California, San Diego School of Medicine, La Jolla, Calif
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Rüegger AD, Coleman L, Hansford JR, McLean N, Dabscheck G. Spinal Cord Hyperintensities in Neurofibromatosis Type 1: Are They the Cord Equivalent of Unidentified Bright Objects in the Brain? Pediatr Neurol 2018; 86:63-65. [PMID: 30174245 DOI: 10.1016/j.pediatrneurol.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Focal areas of T2 hyperintensity are seen on magnetic resonance imaging (MRI) in patients with neurofibromatosis type 1 (NF1). These lesions are commonly known as "unidentified bright objects" of the brain. We have seen similar lesions in the spinal cord of the same patient population. Our aim was to determine the prevalence and characterize the imaging features of these T2 hyperintense spinal cord lesions in children with NF1. METHODS A search of our hospital's medical imaging database yielded all children with NF1 and MRI of the brain and/or spine between February 2014 and April 2017. Medical imaging was reviewed for T2 hyperintense signal changes and medical records were reviewed of those children with T2 hyperintense spinal cord lesions. RESULTS During the study period 155 children underwent a brain MRI and 72 had a spine MRI. One hundred twenty-three (79%) showed multiple cerebral T2 hyperintense lesions and six (8%) had non-contrast enhancing spinal cord T2 hyperintensities with five children having had a follow-up scan. The one child without follow-up imaging was not further pursued. Interval scanning showed stable appearance of the spinal cord lesions in four children and signal reduction in one child. All five children with T2 hyperintense changes in the spinal cord had an MRI brain and all (100%) also exhibited cerebral T2 hyperintensities. CONCLUSIONS Focal areas of signal hyperintensity in the spinal cord are the corollary of the better described cerebral T2 hyperintensities in individuals with NF1.
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Affiliation(s)
- Andrea D Rüegger
- Department of Neurology, The Royal Children's Hospital, Parkville, Victoria, Australia.
| | - Lee Coleman
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Medical Imaging, The Royal Children's Hospital, Parkville, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia
| | - Jordan R Hansford
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; Department of Pediatrics, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Natalie McLean
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Victorian Clinical Genetics Services, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Gabriel Dabscheck
- Department of Neurology, The Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
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18
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Tritt S, Hillenbrand N, Liesirova K, Moein G, Kieslich M, Porto L. Comparison of the detectability of UBOs in Neurofibromatosis Type I patients with proton density-weighted and FLAIR sequences in 3T MRI. Eur J Paediatr Neurol 2018; 22:615-619. [PMID: 29610060 DOI: 10.1016/j.ejpn.2018.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 12/31/2017] [Accepted: 02/13/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In NF 1 patients, significant numbers of so-called unidentified bright objects (UBOs) can be found. The aim of the study was to investigate whether the detectability of UBOs increases at 3T by comparing Proton density-weighted images (PDw) with fluid-attenuated inversion recovery (FLAIR) sequences. PATIENTS AND METHODS A total of 14 NF1 patients (7 male, 7 female, between 8 and 26 years old, mean age 15.4 years) were examined by a 3T magnetic resonance scanner. The presence of UBOs was evaluated on PD-w and FLAIR images by 4 evaluators. Detectability was rated by a three-point scoring system: lesions which were "well defined/detectable", "suspicious" or "detected after a second look". The Wilcoxon signed-rank test was used for comparisons between the raters. The level of significance was P < 0.05. RESULTS Significantly more lesions were marked as "well defined/detectable" in the PD-w Sequence compared to FLAIR at 3T (P < 0.001 for all four evaluators together, as well as for each evaluator separately). In particular, PD-w proved to be superior for detecting UBOs located in the medulla oblongata, dentate nucleus and hippocampal region, regardless of the level of the raters' experience. CONCLUSION This is the first study which compares FLAIR and PD-w at 3T for the diagnosis of UBOs in NF1. At this field strength significantly more UBOs were detected in the PD-w compared to FLAIR sequences, especially for the infratentorial regions. As UBOs occur at very early stages of the disease in patients with suspected NF1, PD-w might aid in the early diagnosis when using 3T scanners.
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Affiliation(s)
- S Tritt
- Institute of Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - N Hillenbrand
- Institute of Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - K Liesirova
- Institute of Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - G Moein
- Department of Paediatric Neurology, Hospital of Goethe University, Frankfurt am Main, Germany
| | - M Kieslich
- Department of Paediatric Neurology, Hospital of Goethe University, Frankfurt am Main, Germany
| | - L Porto
- Institute of Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany
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19
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Quantitative microstructural cerebral changes in neurofibromatosis type 1. Brain Dev 2018; 40:376-382. [PMID: 29373161 DOI: 10.1016/j.braindev.2017.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate microstructural cerebral changes in children with neurofibromatosis type 1 (NF1) based on T2 relaxation time measurements at 3Tesla. METHODS From our dataset of pediatric MRI examinations at 3T 19 pediatric NF1 patients (1.9-14.3 years of age, 9 girls, 10 boys) were retrospectively selected and compared with the previously published group of 44 healthy children (0-16 years of age). MRI examination included a triple echo TSE sequence as basis for T2 maps. T2 relaxation times were measured in 37 brain regions. RESULTS Compared with healthy controls, T2 relaxation times had the tendency to be increased by 1.01% (GM) to 11.85% (dentate nucleus) for NF1 patients. Only in posterior limb of the internal capsule and parietooccipital white matter values were reduced. No differences were observed between both hemispheres. Overall, no strong evidence supporting a difference between NF1 patients with and without optic glioma or with normal and impaired neuropsychological development was observed. CONCLUSIONS Using T2 relaxation times it was possible to describe measurable microstructural differences in multiple brain regions between NF1 patients and healthy children regardless of whether signal abnormalities were visible on conventional images.
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20
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Emerging genotype-phenotype relationships in patients with large NF1 deletions. Hum Genet 2017; 136:349-376. [PMID: 28213670 PMCID: PMC5370280 DOI: 10.1007/s00439-017-1766-y] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/08/2017] [Indexed: 02/07/2023]
Abstract
The most frequent recurring mutations in neurofibromatosis type 1
(NF1) are large deletions encompassing the NF1
gene and its flanking regions (NF1
microdeletions). The majority of these deletions encompass 1.4-Mb and are associated
with the loss of 14 protein-coding genes and four microRNA genes. Patients with
germline type-1 NF1 microdeletions frequently
exhibit dysmorphic facial features, overgrowth/tall-for-age stature, significant
delay in cognitive development, large hands and feet, hyperflexibility of joints and
muscular hypotonia. Such patients also display significantly more cardiovascular
anomalies as compared with patients without large deletions and often exhibit
increased numbers of subcutaneous, plexiform and spinal neurofibromas as compared
with the general NF1 population. Further, an extremely high burden of internal
neurofibromas, characterised by >3000 ml tumour volume, is encountered
significantly, more frequently, in non-mosaic NF1
microdeletion patients than in NF1 patients lacking such deletions. NF1 microdeletion patients also have an increased risk of
malignant peripheral nerve sheath tumours (MPNSTs); their lifetime MPNST risk is
16–26%, rather higher than that of NF1 patients with intragenic NF1 mutations (8–13%). NF1 microdeletion patients, therefore, represent a high-risk group for
the development of MPNSTs, tumours which are very aggressive and difficult to treat.
Co-deletion of the SUZ12 gene in addition to
NF1 further increases the MPNST risk in
NF1 microdeletion patients. Here, we summarise
current knowledge about genotype–phenotype relationships in NF1 microdeletion patients and discuss the potential role of the genes
located within the NF1 microdeletion interval
whose haploinsufficiency may contribute to the more severe clinical
phenotype.
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21
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Wimmer K, Rosenbaum T, Messiaen L. Connections between constitutional mismatch repair deficiency syndrome and neurofibromatosis type 1. Clin Genet 2017; 91:507-519. [PMID: 27779754 DOI: 10.1111/cge.12904] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 12/13/2022]
Abstract
Constitutional mismatch repair (MMR) deficiency (CMMRD) is a rare childhood cancer susceptibility syndrome resulting from biallelic germline loss-of-function mutations in one of the MMR genes. Individuals with CMMRD have high risk to develop a broad spectrum of malignancies and frequently display features reminiscent of neurofibromatosis type 1 (NF1). Evaluation of the clinical findings of genetically proven CMMRD patients shows that not only multiple café-au-lait macules but also any of the diagnostic features of NF1 may be present in a CMMRD patient. This phenotypic overlap may lead to misdiagnosis of CMMRD patients as having NF1, which impedes adequate management of the patients and their families. The spectrum of CMMRD-associated childhood malignancies includes high-grade glioma, acute myeloid leukaemia or rhabdomyosarcoma, also reported as associated with NF1. Reported associations between NF1 and these malignancies are to a large extent based on studies that neither proved the presence of an NF1 germline mutation nor ruled-out CMMRD in the affected. Hence, these associations are challenged by our current knowledge of the phenotypic overlap between NF1 and CMMRD and should be re-evaluated in future studies. Recent advances in the diagnostics of CMMRD should render it possible to definitely state or refute this diagnosis in these individuals.
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Affiliation(s)
- K Wimmer
- Division of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - T Rosenbaum
- Department of Pediatrics, Sana Kliniken Duisburg, Wedau Kliniken, Duisburg, Germany
| | - L Messiaen
- Medical Genomics Laboratory, Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
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22
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Aydin S, Kurtcan S, Alkan A, Guler S, Filiz M, Yilmaz TF, Sahin TU, Aralasmak A. Relationship between the corpus callosum and neurocognitive disabilities in children with NF-1: diffusion tensor imaging features. Clin Imaging 2016; 40:1092-1095. [DOI: 10.1016/j.clinimag.2016.06.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 05/31/2016] [Accepted: 06/29/2016] [Indexed: 11/30/2022]
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23
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Nicita F, Di Biasi C, Sollaku S, Cecchini S, Salpietro V, Pittalis A, Papetti L, Ursitti F, Ulgiati F, Zicari AM, Gualdi GF, Properzi E, Duse M, Ruggieri M, Spalice A. Evaluation of the basal ganglia in neurofibromatosis type 1. Childs Nerv Syst 2014; 30:319-25. [PMID: 23892392 DOI: 10.1007/s00381-013-2236-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Alterations of the brain microstructure and metabolism have been identified in patients with neurofibromatosis type 1 (NF1). In this study, we analyzed the basal ganglia of NF1 subjects without cognitive delay throughout a combined approach with magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) in order to better define the metabolic and microstructural characteristics of these regions and, furthermore, to verify if metabolic and microstructural abnormalities may be present in normally developed NF1 patients. METHODS A 3-T MRI with multivoxel MRS and DTI was performed in 14 NF1 patients and eight controls. N-acetyl-aspartate (NAA), choline (Cho), creatine (Cr) values and ratios, fractional anisotropy, and apparent diffusion coefficient (ADC) were calculated, for a total of four regions of interest (ROI) for each hemisphere. RESULTS NF1 patients, compared to healthy controls, showed (a) decreased NAA in all the four ROI, (b) increased Cho and decreased Cr in three of the four ROI, (c) decreased NAA/Cho ratio in three ROI, and (d) increased ADC in all the four ROI. A trend of increased ADC was present in three of the four ROI of NF1 patients with unidentified bright objects (UBOs) and younger than 18 years. CONCLUSION These data confirm the presence of neuroaxonal damage with myelin disturbances in NF1 patients. We showed that metabolic and microstructural anomalies can be present in the same time in NF1 patients without developmental delay or cognitive deficits. Relations between brain anomalies, UBOs, and cognitive functions need further studies.
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Affiliation(s)
- Francesco Nicita
- Department of Pediatrics, Child Neurology Division, Policlinico Umberto I, "Sapienza", University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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24
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Payne JM, Pickering T, Porter M, Oates EC, Walia N, Prelog K, North KN. Longitudinal assessment of cognition and T2-hyperintensities in NF1: an 18-year study. Am J Med Genet A 2013; 164A:661-5. [PMID: 24357578 DOI: 10.1002/ajmg.a.36338] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 10/14/2013] [Indexed: 11/09/2022]
Abstract
The developmental course of cognitive deficits in individuals with neurofibromatosis type 1 (NF1) is unclear. The objectives of this study were to determine the natural history of cognitive function and MRI T2-hyperintesities (T2H) from childhood to adulthood and to examine whether the presence of discrete T2H in childhood can predict cognitive performance in adulthood. We present cognitive and structural neuroimaging data from 18 patients with NF1 and five sibling controls assessed prospectively across an 18-year period. Longitudinal analyses revealed a significant increase in general cognitive function in patients with NF1 over the study period. Improvements were limited to individuals with discrete T2H in childhood. Patients without lesions in childhood exhibited a stable profile. The number of T2H decreased over time, particularly discrete lesions. Lesions located within the cerebral hemispheres and deep white matter were primarily stable, whereas those located in the basal ganglia, thalamus and brainstem tended to resolve. Our results support the hypothesis that resolution of T2H is accompanied by an improvement in general cognitive performance, possibly as a result of increased efficiency within white matter tracts.
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Affiliation(s)
- Jonathan M Payne
- Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Pediatrics and Child Health, Faculty of Medicine, University of Sydney, Sydney, Australia
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25
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Khan A, Beri S, Baheerathan A, Balki A, Hussain N, Gosalakkal J. Globus pallidus high-signal lesions: A predominant MRI finding in children with neurofibromatosis type 1. Ann Indian Acad Neurol 2013; 16:53-6. [PMID: 23661963 PMCID: PMC3644782 DOI: 10.4103/0972-2327.107702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 04/15/2012] [Accepted: 04/16/2012] [Indexed: 11/16/2022] Open
Abstract
Introduction: Lesions of the brain, recognized as unidentified bright objects (UBOs), are commonly observed as areas of increased T2-weighted signal intensity on magnetic resonance imaging (MRI) in children with neurofibromatosis type 1 (NF1). Identification of these lesions is not currently encompassed in the National Institute of Health (NIH) diagnostic criteria for NF1. Objective: We aimed to determine the prevalence of UBOs in children with NF1 and identify areas of the brain that are commonly affected by these lesions, allowing us to evaluate whether UBOs should be included in the diagnostic criteria for the diagnosis of NF1. Materials and Methods: We reviewed the cranial MRI scans of 22 children who had been diagnosed with sporadic or familial NF1 in accordance with the criteria established by NIH. UBOs were present in 81% of the children with NF1. Results: These lesions have a predilection for specific areas of the brain, including the globus pallidus (72%), cerebellum (66%), brainstem (27%) and cerebral hemispheres (16%). The prevalence of UBOs identified varied significantly with age and sex; they were infrequent in children less than 4 years of age but were common in those aged between 4 and 12 years of age. UBOs were more commonly seen in males (66.6%) compared with females (33.3%). Repeat MRI scan on a subset of these patients with UBOs did not show any significant changes despite a worsening in clinical symptoms. Conclusion and Discussion: We have shown that UBOs are a common finding in children with NF1, and are most prevalent between the ages of 4 and 12 years. Many sites of the brain are affected by these lesions, most notably the globus pallidus and the cerebellum. Further research must be conducted to elucidate the significance of UBOs in patients with NF1 and whether these lesions have any utility in the clinical detection of NF1.
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Affiliation(s)
- Arif Khan
- Department of Pediatric Neurology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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26
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Abstract
Optic pathway gliomas account for 3-5% of all pediatric CNS tumors and represent the most common intrinsic optic nerve tumors. These tumors occur preferentially during the first decade of life and are particularly frequent in children with neurofibromatosis type 1. Although optic pathway gliomas are low-grade tumors, their behavior can be aggressive, and their management is often challenging. Their management includes observation, surgery, chemotherapy and radiation. The role of each modality is discussed as well as current and future developments in treatment, in particular targeted therapies that are currently being investigated.
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Affiliation(s)
- Iris Fried
- The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Uri Tabori
- The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Tarik Tihan
- University of California San Francisco Medical Center-Parnassus, Neuropathology Unit, CA, USA
| | - Arun Reginald
- Division of Ophthalmology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Eric Bouffet
- The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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Johnson KJ, Hussain I, Williams K, Santens R, Mueller NL, Gutmann DH. Development of an international internet-based neurofibromatosis Type 1 Patient registry. Contemp Clin Trials 2013; 34:305-11. [DOI: 10.1016/j.cct.2012.12.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/08/2012] [Accepted: 12/05/2012] [Indexed: 11/29/2022]
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28
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Hervey-Jumper SL, Singla N, Gebarski SS, Robertson P, Maher CO. Diffuse pontine lesions in children with neurofibromatosis type 1: making a case for unidentified bright objects. Pediatr Neurosurg 2013; 49:55-9. [PMID: 24192157 DOI: 10.1159/000355417] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 09/02/2013] [Indexed: 12/21/2022]
Abstract
Using an illustrative case of a presumed pontine unidentified bright object (UBO) with spontaneous lesion regression over 2 years, we review the importance of including UBOs in the differential diagnosis of children with confirmed or possible neurofibromatosis type 1 (NF1) who present with diffuse pontine enlargement and T2-weighted changes on MRI. Asymptomatic children with presumed NF1 and diffuse pontine lesions should not be treated with radiation and should not be biopsied. Prior reports of good prognosis associated with pontine glioma in patients with NF1 may have been unrecognized UBOs in some cases.
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29
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Ferraz-Filho JRL, da Rocha AJ, Muniz MP, Souza AS, Goloni-Bertollo EM, Pavarino-Bertelli EC. Diffusion tensor MR imaging in neurofibromatosis type 1: expanding the knowledge of microstructural brain abnormalities. Pediatr Radiol 2012; 42:449-54. [PMID: 22033857 DOI: 10.1007/s00247-011-2274-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Revised: 08/25/2011] [Accepted: 08/30/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a hereditary disease with a dominant autosomal pattern. In children and adolescents, it is frequently associated with the appearance of T2-weighted hyperintensities in the brain's white matter. MRI with diffusion tensor imaging (DTI) is used to detect white matter abnormalities by measuring fractional anisotropy (FA). OBJECTIVE This study employed DTI to evaluate the relationship between FA patterns and the findings of T2 sequences, with the aim of improving our understanding of anatomical changes and microstructural brain abnormalities in individuals with NF1. MATERIALS AND METHODS Forty-four individuals with NF1 and 20 control subjects were evaluated. The comparative analysis of FA between NF1 and control groups was based on four predetermined anatomical regions of the brain hemispheres (basal ganglia, cerebellum, pons, thalamus) and related the presence or absence of T2-weighted hyperintensities in the brain, which are called unidentified bright objects (UBOs). RESULTS The FA values between the groups demonstrated statistically significant differences (P ≤ 0.05) for the cerebellum and thalamus in patients with NF1, independent of the occurrence of UBOs. CONCLUSIONS Diffusion tensor MR imaging confirms the influence of UBOs in the decrease of FA values in this series of patients with NF1. Additionally, this technique allows the characterization of microstructural abnormalities even in some brain regions that appear normal in conventional MR sequences.
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Affiliation(s)
- José R L Ferraz-Filho
- Radiology Department, Medical School in São José do Rio Preto, 5544 Brigadeiro Faria Lima, São Paulo, Brazil.
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Sabol Z, Resić B, Gjergja Juraski R, Sabol F, Kovac Sizgorić M, Orsolić K, Ozretić D, Sepić-Grahovac D. Clinical sensitivity and specificity of multiple T2-hyperintensities on brain magnetic resonance imaging in diagnosis of neurofibromatosis type 1 in children: diagnostic accuracy study. Croat Med J 2012; 52:488-96. [PMID: 21853543 PMCID: PMC3160695 DOI: 10.3325/cmj.2011.52.488] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim To determine the prevalence, number, and location of multiple (≥2) T2-hyperintensities on brain magnetic resonance imaging (MRI) in children with neurofibromatosis type 1 (NF1) and their correlation with age, and to establish their sensitivity, specificity, and accuracy for the diagnosis of NF1 in children, especially in the early age (2-7 years). Methods We performed a cross-sectional study of 162 patients with NF1 from Croatian Neurofibromatosis Association Database and 163 control children between the ages of 2 and 18 years who underwent brain MRI between 1989 and 2009. Results Multiple T2-hyperintensities were present in 74% of NF1 patients and 1.8% of controls. They were mainly located in the basal ganglia, brainstem, and cerebellum and were significantly decreased in prevalence and number in the older age. T2-hyperintensities had excellent diagnostic accuracy with the area under the receiver operating characteristic (ROC) curve of 0.849 and 95% confidence interval (CI) of 0.805-0.886. The diagnostic sensitivity, specificity, and accuracy rate of T2-hyperintensities for NF1 were highest in the youngest age (2-7 years): 81% (95% CI 71%-89.1%), 99% (95% CI 92.3%-100%), and 85.8 (95% CI 83.3-93.8), respectively. Conclusion This study strongly suggests the inclusion of T2-hyperintensities on brain MRI on the list of diagnostic criteria for NF1, especially in children of early age, when the clinical penetration of the NF1 gene has not yet been completely finished.
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Affiliation(s)
- Zlatko Sabol
- Sabol Outpatient Clinic for Sick Children, Zagreb, Croatia.
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31
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Ferraz-Filho JRL, José da Rocha A, Muniz MP, Souza AS, Goloni-Bertollo EM, Pavarino-Bertelli EC. Unidentified bright objects in neurofibromatosis type 1: conventional MRI in the follow-up and correlation of microstructural lesions on diffusion tensor images. Eur J Paediatr Neurol 2012; 16:42-7. [PMID: 22088602 DOI: 10.1016/j.ejpn.2011.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 06/23/2011] [Accepted: 10/22/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To evaluate the evolution of unidentified bright objects (UBOs) in individuals with neurofibromatosis type 1 (NF1) by serial magnetic resonance imaging (MRI), and to relate this to regional fractional anisotropy (FA). MATERIALS AND METHODS The signal pattern of the T2-weighted sequences in the basal ganglia, thalamus, brain stem, and cerebellum for 27 NF1 individuals and a control group were analyzed by diffusion tensor imaging (DTI). The presence or absence of UBOs in 2 consecutive MRI examinations was related to FA. RESULTS We demonstrated significant differences in FA for the basal ganglia, cerebellum, and thalamus between NF1 patients and controls (P ≤ 0.05), even with a reduction or disappearance of UBOs. CONCLUSIONS MRI allows for adequate monitoring of the temporal and spatial distribution of UBOs in patients with NF1. DTI confirmed changes in FA despite the disappearance or reduction of UBOs, thereby confirming the hypothesis that microstructural damage occurs in specific brain regions of NF1 patients.
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Piscitelli O, Digilio MC, Capolino R, Longo D, Di Ciommo V. Neurofibromatosis type 1 and cerebellar T2-hyperintensities: the relationship to cognitive functioning. Dev Med Child Neurol 2012; 54:49-51. [PMID: 22107256 DOI: 10.1111/j.1469-8749.2011.04139.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ornella Piscitelli
- Unit of Pediatric Neuropsychiatry, Department of Neurosciences, Bambino Gesù Children's Hospital, Rome, Italy
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Hsieh HY, Fung HC, Wang CJ, Chin SC, Wu T. Epileptic seizures in neurofibromatosis type 1 are related to intracranial tumors but not to neurofibromatosis bright objects. Seizure 2011; 20:606-11. [PMID: 21621428 DOI: 10.1016/j.seizure.2011.04.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 03/16/2011] [Accepted: 04/22/2011] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate the relationship between intracranial lesions and epileptic seizures in neurofibromatosis type 1 (NF1) patients. BACKGROUND NF1 is one of the most common autosomal dominant neurocutaneous disorders, and epilepsy is more prevalent in NF1 patients than in the general population. Epileptic seizures were found to be related to various types of intracranial lesions in NF1 patients. METHODS The clinical characteristics of NF1 (1986-2006 in Chung-Gung Memorial Hospital), diagnosed on the basis of the criteria of the National Institutes of Health Consensus Conference (1988), were reviewed by 2 neurologists. We diagnosed epileptic seizures of NF1 patients on the basis of clinical appearances and a history of antiepileptic drugs. Magnetic resonance images were also evaluated by 2 neuroradiologists to confirm the locations of brain tumors or neurofibromatosis bright objects (NBOs). The locations of NBOs were classified into 4 categories: cortex and hippocampus, subcortical white matter, basal ganglia, and infratentorial area. The association between the location of the lesions and the occurrence of seizure in NF1 patients was analyzed statistically. RESULTS The medical records of 630 NF1 patients were reviewed. In this cohort, 37 (5.87%) NF1 patients had epileptic seizures. The patients include 22 males (59.5%) and 15 females (40.5%). The mean seizure onset age was 14.8 years (2 months to 72 years). The most common seizure pattern was partial onset seizures, 3 simple partial seizures, and 14 complex partial seizures. Other seizure types found include 15 primary generalized seizures (2 absence seizures and 13 generalized tonic-clonic seizures), 2 infantile spasms, and 3 unclassified. A total of 172 (23 with epilepsy and 149 without epilepsy) NF1 patients underwent MRI examinations. NBOs were identified in 16 (69.6%) epilepsy patients and in 108 (72.5%) patients without epilepsy. The location or the number of these intracranial lesions does not show significant correlation with the occurrence of epilepsy in our cohort. Among 11 NF1 patients with intracranial tumors, 4 patients had seizures (36.36%), vs. 19 out of 161 NF1 patients (11.80%) without tumors. CONCLUSION The occurrence of epileptic seizures in NF1 patients is related to intracranial tumors but not to NBOs.
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Affiliation(s)
- Hsiang-Yao Hsieh
- Department of Neurology, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taipei, Taiwan
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Hayashi Y, Nakada M, Mohri M, Murakami H, Kawahara N, Hamada JI. Ganglioglioma of the thoracolumbar spinal cord in a patient with neurofibromatosis type 1: a case report and literature review. Pediatr Neurosurg 2011; 47:210-3. [PMID: 22041518 DOI: 10.1159/000331569] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/04/2011] [Indexed: 11/19/2022]
Abstract
Gangliogliomas of the spinal cord are rare, and the conus medullaris is an extremely rare site for their occurrence. The authors present a case in which a ganglioglioma was found in the thoracolumbar spinal cord, including the conus medullaris, of a 5-year-old female patient with neurofibromatosis type 1 (NF1) who presented with paraparesis and urinary disturbance. MRI revealed an intramedullary lesion within the thoracolumbar spinal cord, including the conus medullaris, which was surgically removed. Pathological investigation showed a ganglioglioma consisting of glioneuronal tumor cells. This is the first report to provide a pathological description of a spinal cord ganglioglioma in a patient with NF1. Because gangliogliomas usually have a good prognosis following resection, it is important to clearly distinguish them from other NF1-associated lesions, even though ganglioglioma of the thoracolumbar spinal cord, including the conus medullaris, is an extremely rare condition.
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Affiliation(s)
- Yutaka Hayashi
- Department of Neurosurgery, Kanazawa University Hospital, Kanazawa, Japan.
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Feldmann R, Schuierer G, Wessel A, Neveling N, Weglage J. Development of MRI T2 hyperintensities and cognitive functioning in patients with neurofibromatosis type 1. Acta Paediatr 2010; 99:1657-60. [PMID: 21039823 DOI: 10.1111/j.1651-2227.2010.01923.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients with neurofibromatosis type 1 (NF1), cognitive deficits are frequent manifestations. They are associated with focal areas of high signal intensity (T2H) on T₂-weighted MRI of the brain. Changes in T2H may affect cognitive development. Our study was to analyse the relations between the long-term development of T2H development and the cognitive abilities in patients with NF1. METHOD In a controlled prospective study, we investigated 67 patients with NF1 for their IQ with the patients having T2H (MRI) examination. Assessments and MRI were repeated at a 3- year follow-up. RESULTS Patients without T2H performed at the average IQ level. Patients with stable T2H performed below average level but within normal limits of IQ. Patients with T2H that decreased over study period performed well below normal limits at first examination but within limits at follow-up. Stable T2H were found primarily in the cerebellum and the capsula interna. T2H that decreased were found primarily in the thalamus and the basal ganglia. CONCLUSIONS T2H in the cerebellum and the capsula interna are more permanent but exert a minor left shift in IQ. T2H in the thalamus or the basal ganglia are related to severely reduced performance. Decreasing they give way for performance improvement. There may be a different pathology in T2H related to the intracranial regions the T2H affect in patients with NF1.
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Affiliation(s)
- Reinhold Feldmann
- Department of Pediatrics, University Hospital of Münster, Münster, Germany.
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Barbier C, Chabernaud C, Barantin L, Bertrand P, Sembely C, Sirinelli D, Castelnau P, Cottier JP. Proton MR spectroscopic imaging of basal ganglia and thalamus in neurofibromatosis type 1: correlation with T2 hyperintensities. Neuroradiology 2010; 53:141-8. [PMID: 20959972 DOI: 10.1007/s00234-010-0776-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Accepted: 09/23/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Neurofibromatosis type 1 (NF1) is frequently associated with hyperintense lesions on T2-weighted images called "unidentified bright objects" (UBO). To better characterize the functional significance of UBO, we investigate the basal ganglia and thalamus using spectroscopic imaging in children with NF1 and compare the results to anomalies observed on T2-weighted images. METHODS Magnetic resonance (MR) data of 25 children with NF1 were analyzed. On the basis of T2-weighted images analysis, two groups were identified: one with normal MR imaging (UBO- group; n = 10) and one with UBO (UBO+ group; n = 15). Within the UBO+ group, a subpopulation of patients (n = 5) only had lesions of the basal ganglia. We analyzed herein seven regions of interest (ROIs) for each side: caudate nucleus, capsulo-lenticular region, lateral and posterior thalamus, thalamus (lateral and posterior voxels combined), putamen, and striatum. For each ROI, a spectrum of the metabolites and their ratio was obtained. RESULTS Patients with abnormalities on T2-weighted images had significantly lower NAA/Cr, NAA/Cho, and NAA/mI ratios in the lateral right thalamus compared with patients with normal T2. These abnormal spectroscopic findings were not observed in capsulo-lenticular regions that had UBO but in the thalamus region that was devoid of UBO. CONCLUSION Multivoxel spectroscopic imaging using short-time echo showed spectroscopic abnormalities in the right thalamus of NF1 patients harboring UBO, which were mainly located in the basal ganglia. This finding could reflect the anatomical and functional interactions of these regions.
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Affiliation(s)
- Charlotte Barbier
- Department of Neuroradiology, CHRU & Tours University, Tours 37000, France
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Okazaki K, Kakita A, Tanaka H, Kimura K, Minagawa M, Morita T, Takahashi H. Widespread ischemic brain lesions caused by vasculopathy associated with neurofibromatosis type 1. Neuropathology 2010; 30:627-33. [DOI: 10.1111/j.1440-1789.2009.01097.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mizukoshi W, Kozawa E, Kuramochi A, Uchino A, Kimura F. Quantitative assessment of water diffusion changes in brains of children with neurofibromatosis type I using apparent diffusion coefficient. Neuroradiol J 2009; 21:839-43. [PMID: 24257055 DOI: 10.1177/197140090802100615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Accepted: 10/26/2008] [Indexed: 11/17/2022] Open
Abstract
We measured diffusion changes in the brains of children with neurofibromatosis type 1 (NF1). Using diffusion-weighted and conventional magnetic resonance (MR) images of 42 children with NF1 (19 girls, 23 boys; 7 months-16 years, mean 6.8 years) and 42 age-matched controls (20 boys, 22 girls; 6 months-17 years, mean, 6.9 years), we calculated the apparent diffusion coefficient (ADC) from the automatically generated ADC maps and placed regions of interest in the pons, middle cerebellar and cerebral peduncles, thalami, globus pallidi and frontal white matter. Evaluating only normal-appearing regions on conventional images, we compared mean ADCs using the unpaired Student t test. Means were not significantly different in frontal white matter but were larger in the other regions in the NF1 (P < 0.01). Although conventional MR showed normal intensity, ADCs of the pons, middle cerebellar and cerebral peduncles, thalami and globus pallidi were significantly larger in the NF1.
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Affiliation(s)
- W Mizukoshi
- Department of Diagnostic Radiology, International Medical Center of Saitama Medical University; Hidaka, Saitama, Japan -
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Abstract
Neurofibromatosis (NF) 1 and 2 are multisystem disorders associated with a variety of neoplastic and non-neoplastic manifestations that typically progress in severity during the lifetime of the affected patient. The importance of appropriately diagnosing these disorders stems from the fact that the natural history of an associated neoplasm, such as a peripheral nerve tumor or an optic glioma, may be significantly different depending on whether or not the lesion arises in a person with NF. In addition, the indications for therapeutic intervention, hierarchy of treatment options and long-term management goals may differ substantially for patients with NF-related versus sporadic tumors. Finally, recognition of the diagnosis comprises an essential step for providing appropriate multidisciplinary evaluation and counseling to affected patients and their families. This article addresses the principal manifestations of these disorders and provides a contemporary review of the diagnostic and therapeutic issues that arise in children with NF1 and NF2.
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Affiliation(s)
- I F Pollack
- Department of Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh Brain Tumor Center, PA 15213.
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Ullrich NJ, Raja AI, Irons MB, Kieran MW, Goumnerova L. BRAINSTEM LESIONS IN NEUROFIBROMATOSIS TYPE 1. Neurosurgery 2007; 61:762-6; discussion 766-7. [DOI: 10.1227/01.neu.0000298904.63635.2d] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
The presence of multiple, nonenhancing areas of hyperintensity without mass effect are well recognized on magnetic resonance imaging scans in children with neurofibromatosis type 1 (NF1). Focal regions of brainstem enlargement with or without contrast enhancement are considerably less frequent; the neuroimaging characteristics and natural history of these lesions in patients with NF1 are poorly understood. The objective of this study was to define the clinical and radiographic course of brainstem lesions in children with NF1.
METHODS
We retrospectively reviewed the neuroimaging studies of all patients with NF1 between 2000 and 2006 to determine the prevalence of brainstem lesions. Clinical features, previous treatments, and neuroimaging studies of the brainstem lesions were evaluated.
RESULTS
A total of 125 patients underwent neuroimaging studies; of these, 23 patients (18.4%) showed evidence of brainstem mass lesions and had follow-up magnetic resonance imaging scans available for review. Eight patients in this cohort received additional treatment with surgery, radiation, or chemotherapy. Of these, two patients underwent surgery for lesions distant from the brainstem, and six patients underwent treatment that included the brainstem and were thought to potentially affect the natural history or progression of the brainstem abnormality. With a median follow-up period of 67 months for untreated patients (17 out of 23) and 102 months for patients who received therapy (six out of 23), only one previously untreated patient experienced radiographic and clinical progression. All patients but one remain alive.
CONCLUSION
We conclude that brainstem lesions in NF1 are prevalent and behave in a biologically indolent nature; most do not require therapeutic intervention.
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Affiliation(s)
- Nicole J. Ullrich
- Department of Neurology, Children's Hospital Boston, Boston, Massachusetts
| | - Ali I. Raja
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mira B. Irons
- Department of Genetics, Children's Hospital Boston, Boston, Massachusetts
| | - Mark W. Kieran
- Department of Hematology and Oncology, Children's Hospital Boston, Boston, Massachusetts
| | - Liliana Goumnerova
- Department of Neurosurgery, Children's Hospital Boston, Boston, Massachusetts
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Hyman SL, Gill DS, Shores EA, Steinberg A, North KN. T2 hyperintensities in children with neurofibromatosis type 1 and their relationship to cognitive functioning. J Neurol Neurosurg Psychiatry 2007; 78:1088-91. [PMID: 17299016 PMCID: PMC2117545 DOI: 10.1136/jnnp.2006.108134] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 12/19/2006] [Accepted: 01/12/2007] [Indexed: 11/03/2022]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a single gene disorder associated with a high frequency of cognitive deficits and a complex cognitive phenotype. These cognitive deficits have been associated with focal areas of high signal intensity on T2 weighted MRI images but the relationship remains controversial. METHOD A cohort of 76 children with NF1 and 45 unaffected sibling controls (aged 8-16 years) underwent extensive neuropsychological assessment, with the NF1 children having MRI examinations. RESULTS The presence or number of T2 hyperintensities (T2H) was not associated with cognitive dysfunction. However, the location of discrete (well circumscribed) T2H in the thalamus was associated with severe and generalised cognitive impairment. More diffuse lesions in the thalamus were also associated with reductions in IQ but the effects were less marked compared with the discrete lesions. Comparing children with NF1 to their unaffected siblings revealed more subtle effects of the lesions on cognitive ability. CONCLUSIONS T2H cannot be used in general as a radiological marker for cognitive deficits in children with NF1; however, lesions in the thalamus are strongly associated with cognitive impairment. It is possible that lesions in the thalamus in conjunction with more general thalamic hypometabolism may compound the level of thalamic dysfunction, resulting in cognitive deficits well beyond those produced by T2H in other regions.
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Affiliation(s)
- Shelley L Hyman
- Neurogenetics Research Unit at the Children's Hospital at Westmead, Discipline of Paediatrics and Child Health Faculty of Medicine, University of Sydney, Sydney, Australia.
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Alorainy IA. Pattern of congenital brain malformations at a referral hospital in Saudi Arabia: an MRI study. Ann Saudi Med 2006; 26:28-37. [PMID: 16521872 PMCID: PMC6078548 DOI: 10.5144/0256-4947.2006.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2005] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND More than 2000 different congenital cerebral malformations have been described in the literature, for which several classification systems have been proposed. With the help of these classification systems, it is now possible, with neuroimaging, to time neuroembryologic events. Magnetic resonance imaging (MRI), in particular, is useful in studying these malformations. This study evaluated the pattern of congenital brain malformations in a university referral hospital setting. PATIENTS AND METHODS The records of all MRI brain examinations at our hospital over a period of 3 years for children younger than 15 years of age were reviewed. Cases of congenital cerebral malformations were analyzed by sex, age at presentation, type of congenital cerebral malformation, and other associated congenital cerebral malformations. RESULTS Of the 808 MR examinations of different parts of the body for children in the study period, 719 (89%), on 581 patients, were of the brain. Eighty-six children (14.8%) were found to have single or multiple congenital brain malformations. In these children, 114 congenital brain malformations were identified, the commonest being cortical migrational defects (25 patients, 22%), neural tube closure defects (22 patients, 19%), and corpus callosum dysgenesis (22 patients,19%). The least common was vascular malformation. Sixteen patients (18.6%) had more than one congenital brain malformation. CONCLUSION Neural tube closer defects, cortical migrational abnormalities, and corpus callosum anomalies were the commonest congenital brain malformations, while vascular malformations were the least common. Most of the identified malformations demonstrated the usual pattern, but a few showed unusual patterns and associations.
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Affiliation(s)
- Ibrahim A Alorainy
- Department of Radiology and Diagnostic Imaging, College of Medicine and King Khalid Univerity Hospital, King Saud University, Riyadh, Saudi Arabia.
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Alkan A, Sigirci A, Kutlu R, Ozcan H, Erdem G, Aslan M, Ates O, Yakinci C, Egri M. Neurofibromatosis type 1: Diffusion weighted imaging findings of brain. Eur J Radiol 2005; 56:229-34. [PMID: 15963674 DOI: 10.1016/j.ejrad.2005.05.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Revised: 05/11/2005] [Accepted: 05/13/2005] [Indexed: 11/21/2022]
Abstract
PURPOSE The purposes of this study were to evaluate the differences in apparent diffusion coefficient (ADC) values between infra and supratentorial unidentified bright objects (UBOs), between UBOs and normal appearing side (NAS, contralateral regions of the UBOs and/or normal appearing region without UBOs) in the neurofibromatosis type 1 patients (NF1) and control group and also to investigate correlation between age and ADC values. METHODS A total of 30 patients and 26 healthy controls were included. The MRI examination consisted of routine imaging and diffusion weighted imaging (DWI). Seven distinct locations (frontal, parieto-occipital and cerebellar white matter, globus pallidum, thalamus, hippocampus, and midbrain) were selected for the analysis. The ADC values were calculated directly from these automatically generated ADC maps with ROI. RESULTS The ADC values of UBOs were significantly increased in cerebellar white matter, hippocampus, globus pallidum, midbrain, and thalamus when compared with NAS and control group. There were statistically significant differences between NAS and control group in the ADC values obtained from hippocampus and thalamus. There were statistically significant differences between supra and infratentorial UBOs in ADC values. There was a negative correlation between age and the ADC values obtained from normal appearing midbrain, hippocampus, thalamus, and globus pallidum. CONCLUSION ADC values both in UBOs and in the normal appearing locations as hippocampus and thalamus were detected to be higher in the patients with NF1. The detection of lesions might be independent of MRI appearance in NF1, i.e. although the brain is affected, MRI appearance may be normal. Therefore, DWI and ADC values should also be utilized in the delineation of brain involvement of NF1 patients.
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Affiliation(s)
- Alpay Alkan
- Department of Radiology, Turgut Ozal Medical Center, Inonu University School of Medicine, 44069 Malatya, Turkey.
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Abstract
Neurocutaneous syndromes are disorders characterized by a neurological abnormality and cutaneous manifestations. Three of the more common neurocutaneous syndromes are Sturge-Weber syndrome, tuberous sclerosis, and neurofibromatosis. This review focuses on the cognitive and behavioral features of these syndromes.
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Affiliation(s)
- Charles M Zaroff
- Comprehensive Epilepsy Center, New York University, 403 East 34th Street, New York, NY 10016, USA.
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Tognini G, Ferrozzi F, Garlaschi G, Piazza P, Patti A, Virdis R, Bertolino C, Bertolino G, Manfredini D, Zompatori M, Crisi G. Brain Apparent Diffusion Coefficient Evaluation in Pediatric Patients With Neurofibromatosis Type 1. J Comput Assist Tomogr 2005; 29:298-304. [PMID: 15891494 DOI: 10.1097/01.rct.0000162406.71300.b7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The most frequent intracranial appearance in children with neurofibromatosis type 1 (NF1) is represented by the presence of hyperintense lesions on T2-weighted images, the so-called "unidentified bright objects" (UBOs). Di Paolo demonstrated that these lesions represent foci of myelin vacuolization with increased water content. The aim of this study was to investigate the isotropic apparent diffusion coefficient (ADC) values within the UBOs and normal-appearing brain and at the regressed UBO sites. METHODS Fifteen consecutive children with NF1 underwent magnetic resonance diffusion evaluation of the brain. Fifteen healthy age- and sex-matched children constituted the control group. Apparent diffusion coefficient maps were obtained, and regions of interest were placed bilaterally in 8 different areas. Two cortical areas were evaluated using single-pixel analysis. Apparent diffusion coefficient values within the UBOs were calculated by using irregular regions of interest. Regressed UBO sites were investigated by using circular regions of interest. Apparent diffusion coefficient values within the different areas were compared using a t test. RESULTS Compared with the controls, NF1 patients showed higher ADC values (P < 0.001) in all locations. In the NF1 group, the mean ADC value in the UBOs was higher than in other locations (P < 0.001). The mean ADC value within the regressed UBO sites was higher than in the normal-appearing locations (P < 0.001). CONCLUSIONS The higher ADC values in children with NF1 suggest an increase in water content of the normal-appearing brain. The UBOs are the areas with the highest water content. The regressed UBOs sites show higher water content than the normal-appearing areas.
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Affiliation(s)
- Giuseppe Tognini
- Dipartimento di Scienze Cliniche, Sezione Diagnostica per Immagini, Università di Parma, Parma, Italy.
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Mentzel HJ, Seidel J, Fitzek C, Eichhorn A, Vogt S, Reichenbach JR, Zintl F, Kaiser WA. Pediatric brain MRI in neurofibromatosis type I. Eur Radiol 2004; 15:814-22. [PMID: 15290066 DOI: 10.1007/s00330-004-2433-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2004] [Revised: 06/08/2004] [Accepted: 07/01/2004] [Indexed: 11/28/2022]
Abstract
Neurofibromatosis (NF) is the most common of the phakomatoses, with a prevalence of 1 in 3-4,000. Many organ systems can be affected. In addition to multiple peripheral neurofibromas, NF I predisposed to CNS tumors including optic glioma, astrocytoma and plexiform neurofibroma. The purpose of this pictorial review is to illustrate characteristic brain MR imaging lesions in children with NF I and to give some recommendations about diagnostic imaging procedures in children suffering from NF I. Typical findings in brain MRI are hyperintense lesion on T2-weighted images, so-called unknown bright objects, which may be useful as an additional imaging criterion for NF I. Contrast administration is necessary in MR studies to maximize tumor detection and characterization, to add confidence to the diagnosis of benign probable myelin vacuolization, and to document stability of neoplasm on follow-up examinations. We recommend to perform serial MR imaging in children every 12 months. The frequency of follow-up in children with known brain tumors will vary with the tumor grade, biological activity and treatment.
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Affiliation(s)
- Hans-J Mentzel
- Department of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University Jena, Bachstrasse 18, 07740 Jena, Germany.
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Rodriguez D, Young Poussaint T. Neuroimaging findings in neurofibromatosis type 1 and 2. Neuroimaging Clin N Am 2004; 14:149-70, vii. [PMID: 15182813 DOI: 10.1016/j.nic.2004.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Neuroimaging, particularly MR imaging, plays an important role in the diagnosis and management of the patient with neurofibromatosis type 1 and 2. These phakomatoses are complex disorders affecting multiple cell types and multiple systems of the body with a wide range of expression. This article summarizes the neuroradiologic central nervous system findings in these neurocutaneous disorders.
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Affiliation(s)
- Diana Rodriguez
- Department of Radiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
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Alkan A, Sarac K, Kutlu R, Yakinci C, Sigirci A, Aslan M, Ozcan H, Yologlu S. Proton MR spectroscopy features of normal appearing white matter in neurofibromatosis type 1. Magn Reson Imaging 2003; 21:1049-53. [PMID: 14684211 DOI: 10.1016/s0730-725x(03)00209-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To determine whether differences exist between neurofibromatosis type 1 (NF1) patients with or without focal lesions and healthy normal volunteers in the metabolite ratios of normal appearing white matter, 27 patients with NF1 (with parenchymal lesion, MR positive, n: 17; without parenchymal lesions, MR negative, n: 10) and 20 healthy volunteers underwent MRI and short TE (31 ms) proton MR spectroscopy (MRS). In 17 patients with parenchymal lesions, 61 focal lesions were detected by MRI. MRS was performed from normal appearing frontal and posterior parietal white matter (FWM and PWM) in NF1 and from control groups. NAA/Cr, Cho/Cr and MI/Cr ratios were calculated. Significant increase in Cho/Cr and MI/Cr ratios were found in FWM and PWM in MR negative and positive groups when compared to control group. NAA/Cr ratio in MR positive group was significantly decreased in FWM compared to control group. There were no significant differences between FWM and PWM in all metabolite ratios of MR negative group. MI/Cr ratio in MR positive group was significantly elevated in PWM compared to FWM. Metabolite changes detected by MRS could indicate demyelination and gliosis in normal appearing white matter in all NF1 patients, and additionally neuroaxonal damage in the FWM of NF1 patients with focal lesions. For that reason, in the clinical evaluation and follow-up of these patients MRS features of normal appearing white matter should be considered in addition to focal lesions.
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Affiliation(s)
- Alpay Alkan
- Department of Radiology, Inonu University School of Medicine, Malatya, Turkey.
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Poissant SF, Megerian CA, Hume D. Cochlear implantation in a patient with neurofibromatosis type 1 and profound hearing loss: evidence to support a cochlear site of lesion. Otol Neurotol 2003; 24:751-6. [PMID: 14501452 DOI: 10.1097/00129492-200309000-00011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the efficacy of cochlear implantation in an individual with neurofibromatosis type 1 and profound hearing loss and to determine, to the extent possible in a living subject, the site of lesion of the hearing loss in an individual with neurofibromatosis type 1. STUDY DESIGN Postoperative assessment of an adult male with neurofibromatosis type 1. SETTING The study was completed in the Departments of Otolaryngology and Audiology, University of Massachusetts Medical Center, Massachusetts. PATIENTS One adult male with neurofibromatosis type 1 and bilateral, chiefly profound, sensorineural hearing loss. INTERVENTIONS The subject underwent cochlear implantation as treatment of bilateral, chiefly profound sensorineural hearing loss. MAIN OUTCOME MEASURES Outcome measures include results of electrical auditory brainstem response testing, electrical compound action potential measures, and speech recognition scores. RESULTS Results of testing revealed expected latencies of waves II, III, and V of the electrical auditory brainstem response, measurable compound action potentials across virtually the entire length of the electrode array, and high levels of open-set, auditory-only speech understanding. CONCLUSIONS This is the first case report describing the outcome of cochlear implantation in a patient with neurofibromatosis type 1. Composite test results support the absence of VIIIth nerve degeneration or other anomalies, indicating a cochlear site of lesion for the hearing loss in this patient. Based on the results of this investigation, standard cochlear implantation should be considered a viable option and the first line of therapy for the treatment of bilateral, severe to profound sensorineural hearing loss in patients with neurofibromatosis type 1 and normal, VIIIth nerve radiographic findings.
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Affiliation(s)
- Sarah F Poissant
- Department of Communication Disorders, University of Massachusetts, Amherst, MA 01003, USA.
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