The cranial MRI appearance of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy in a family

Abstract

Objective To recognize the cranial MRI appearance in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy(CADASIL). Methods Five patients with CADASIL from two generations in a family underwent routine MRI and MRA examinations.Three patients with CADASIL were confirmed by the Notch3 genetic testing and the vascular pathological Results and one was diagnosed on basis of MR and clinical manifestations. The imaging data from 4 patients with CADASIL were analyzed.Results Four cases achieved preliminary diagnosis of CADASIL and one was excluded by MRI.In 4 patients with CADASIL,bilateral symmetrical,confluent white matter lesions in the subcortical and Deriventricular regions were seen frequently in the temporal,frontal and parietal lobes,but the occipital lobes were less involved.These lesions appeared as long T1 and long T2 signal.O'Sul]ivan sign was shown in all cases and subcortical lacunar lesions was seen in 2 cases. In the centrum semiovale,well-defined,round or oval cystic infarcts(black holes)were demonstrated in 3 cases and multiple tiny round enlarged perivascular spaces(pepperpot appearance)in all cases.The corpus callosum was involved in all cases,and it was evidently atrophic in 2 cases.The anterior part of internal capsule and external capsule were were present in the basal ganglia and brainstem. Only one case revealed a small infarct in the right cerebellum. Four Datients shared mild or moderate atrophy of brainstem, cerebellum and cerebrum. No marked abnorillalitv of large vessels was seen in all cerebral MRA. Conclusions The cranial MRI appearance in CADASIL shows some characteristics.MRI may give some infotznation in the preliminary diagnosis or exclusion of CADASIL. Key words: Leukoencephalopathy,progressive multifocal; Magnetic resonance imaging