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White matter alteration and cerebellar atrophy are hallmarks of brain MRI in alpha-mannosidosis

. 2021 Mar ; 132 (3) : 189-197. [epub] 20201203

Language English Country United States Media print-electronic

Document type Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't

OBJECTIVE: Despite profound neurological symptomatology there are only few MRI studies focused on the brain abnormalities in alpha-mannosidosis (AM). Our aim was to characterize brain MRI findings in a large cohort of AM patients along with clinical manifestations. METHODS: Twenty-two brain MRIs acquired in 13 untreated AM patients (8 M/5F; median age 17 years) were independently assessed by three experienced readers and compared to 16 controls. RESULTS: Focal and/or diffuse hyperintense signals in the cerebral white matter were present in most (85%) patients. Cerebellar atrophy was common (62%), present from the age of 5 years. Progression was observed in two out of 6 patients with follow-up scans. Cortical atrophy (62%) and corpus callosum thinning (23%) were already present in a 13-month-old child. The presence of low T2 signal intensity in basal ganglia and thalami was excluded by the normalized signal intensity profiling. The enlargement of perivascular spaces in white matter (38%), widening of perioptic CSF spaces (62%), and enlargement of cisterna magna (85%) were also observed. Diploic space thickening (100%), mucosal thickening (69%) and sinus hypoplasia (54%) were the most frequent non-CNS abnormalities. CONCLUSION: White matter changes and cerebellar atrophy are proposed to be the characteristic brain MRI features of AM. The previously reported decreased T2 signal intensity in basal ganglia and thalami was not detected in this quantitative study. Rather, this relative MR appearance seems to be related to the diffuse high T2 signal in the adjacent white matter and not the gray matter iron deposition that has been hypothesized.

Center for Inherited Metabolic Disorders Department of Paediatrics National Institute of Children's Diseases and Faculty of Human Medicine Comenius University in Bratislava Bratislava Slovakia

Department of Pediatrics and Inherited Metabolic Disorders 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Pediatrics and Inherited Metabolic Disorders 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic; Department of Pediatrics 1st Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic

Department of Pediatrics Division of Blood and Marrow Transplantation University of Minnesota Minneapolis MN USA

Department of Radiology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Radiology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic; Department of Neurology and Center of Clinical Neuroscience 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Radiology University of Minnesota Minneapolis MN USA

Division of Clinical Behavioral Neuroscience Department of Pediatrics University of Minnesota Minneapolis MN USA

Division of Clinical Behavioral Neuroscience Department of Pediatrics University of Minnesota Minneapolis MN USA; Center for Magnetic Resonance Research University of Minnesota Minneapolis MN USA

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