Imaging
Tuberous Sclerosis
- Preliminary Diagnosis: Tuberous sclerosis
-
I. What imaging technique is first-line for this diagnosis
- II. Describe the advantages and disadvantages of this technique for diagnosis of tuberous sclerosis.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of tuberous sclerosis.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Tuberous sclerosis
I. What imaging technique is first-line for this diagnosis
MRI with contrast
MR spectroscopy can be performed for accurately diagnosing associated cortical tubers and subependymal nodules
II. Describe the advantages and disadvantages of this technique for diagnosis of tuberous sclerosis.
Advantages
Often diagnostic in the appropriate clinical setting.
Useful as a surveillance imaging technique in young children and adolescents in monitoring for development of subependymal giant cell astrocytoma (SEGA)
Able to localize anatomically and define the extent of disease better than any other imaging modality
Does not utilize ionizing radiation
Disadvantages
Expensive
Time-consuming
Prone to motion artifact
Unable to differentiate quiescent tubers from active tubers that are associated with a seizure focus
MR with contrast can be used only in patients with adequate renal function (i.e., GFR >30)
III. What are the contraindications for the first-line imaging technique?
Patients with non-MR compatible metallic hardware and certain foreign bodies
IV. What alternative imaging techniques are available?
Contrast enhanced and non-contrast enhanced CT
PET/SPECT nuclear medicine imaging
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of tuberous sclerosis.
Contrast enhanced and non-contrast CT
Advantages
Able to detect enhancing subependymal nodules (SEN) characteristic in tuberous sclerosis
Can be used to follow enlarging SEN worrisome for developing SEGA
Can be used to detect calcified SEN and cortical/subcortical tubers to better effect than MRI
Faster than MRI and less susceptible to motion artifact
Disadvantages
Lacks anatomic resolution of MRI
Not as sensitive or specific as MRI in the detection of cranial lesions associated with tuberous sclerosis
Exposes the patient to ionizing radiation
PET/SPECT nuclear medicine imaging
Advantages
Able to differentiate active from non-active cortical/subcortical tubers, which in turn helps surgical planning if necessary
Able to differentiate epileptogenic foci in tuberous sclerosis
Able to differentiate SEGA from SEN
Disadvantages
Lacks anatomic resolution compared with both CT and MR
Easily misses lesions under 1.5 cm in size
Exposes the patient to ionizing radiation
VI. What are the contraindications for the alternative imaging techniques?
Contrast enhanced and non-contrast CT
Contraindicated in pregnant patients, especially during the first two trimesters.
CT with contrast is contraindicated in patients with end-stage renal disease who are not on dialysis.
PET/SPECT nuclear medicine imaging
Contraindicated in pregnant patients
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