Tuberous sclerosis: diffusion MRI findings in the brain

Diffusion MRI has mainly been used for detection of acute ischemia, and for distinction of cytotoxic and vasogenic edema. We applied diffusion MRI in patients with tuberous sclerosis in order to evaluate diffusion imaging characteristics of parenchymal changes. Five children with known tuberous sclerosis were included in this study. The MRI examinations were performed on a 1.5-T MR unit. Diffusion MRI was obtained using the echo-planar imaging sequence. Apparent diffusion coefficient (ADC) values from the abnormal brain parenchyma were: calculated directly from automatically generated ADC maps. Seven normal children were available for comparison. In this control group the mean ADC value of the normal white matter was 0.84 +/- 0.12 x 10(-3) mm(2)/s. In tuberous sclerosis patients the mean ADC value of the white matter hamartomas (n = 20) was apparently high (1.52 +/- 0.24 x 10(-3) mm(2)/s) compared with that of normal white matter. The ADC value of calcified hamartomas was zero. The ADC value within a giant cell tumor was 0.89 x 10(-3) mm(2)/s, similar to that of normal cerebral white matter. The ADC maps were superior to b = 1000 s/mm(2) (true diffusion) images with respect to lesion evaluation, and they provided mathematical information on tissue integrity. With respect to detection of the exact numbers and sizes of the parenchymal hamartomas fluid-attenuated inversion recovery images were superior to ADC maps. It is believed that diffusion MRI can be useful in evaluation of various parenchymal changes associated with tuberous sclerosis. Further studies on tuberous sclerosis, and on various brain lesions, would provide increasing data on this relatively new MRI sequence.