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Images in Neurology |

Diffusion Tensor Imaging at 3 T in Bilateral Schizencephaly With Interruption of the Corpus Callosum

Thomas Kau, MD; Makki Malek, PhD; Jens Teichler, MD; Christian J. Kellenberger, MD, Doz; Eugen Boltshauser, MD, Prof; Ianina Scheer, MD
Arch Neurol. 2010;67(12):1531-1532. doi:10.1001/archneurol.2010.311.
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A 21-month-old girl was referred for magnetic resonance imaging (MRI) of the brain. She had a history of spastic tetraparesis with predominance on the left side. Conventional MRIs (Figure, A-C) revealed bilateral closed-lip schizencephaly, absence of the septum pellucidum, and abnormally oriented gyri of the right hemisphere. The schizencephalic clefts were typically lined by dysplastic gray matter with uncommon extension to the midline on the right side. Diffusion tensor imaging (Figure, D and E) showed distortion of right-hemispheric white matter fibers and deviation of the left superior longitudinal fascicle. Complete interruption of the right cingulum and the trunk of the corpus callosum was depicted by fiber tracking (Figure, F).

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Two axial, T2-weighted, inversion recovery, fast spin echo, 2/2.2 magnetic resonance images (A and B) depict bilateral closed-lip schizencephaly (arrows), and additionally, sagittal orientation of right-hemispheral gyri (arrow) is shown. C, A sagittal, T1-weighted, fast RF-spoiled gradient echo, 1.3/1.3 magnetic resonance image shows that right-sided cleft extension to the midline leads to interruption of the callosal trunk (arrow). In principal eigenvector maps obtained from diffusion tensor imaging, color maps corresponding to the main directions of fiber orientation (blue, cranial-caudal; green, anterior-posterior; red, right-left) demonstrate medial deviation of the left-hemispheral superior longitudinal fascicle toward the cingulum (green; arrows) (D) and right-hemispheral distortion of callosal fibers (red; arrows) (E). F, Three-dimensional fiber tract reconstruction obtained from diffusion tensor imaging superimposed on an axial fractional anisotropy map depicts interruption of the right-hemispheral cingulum. P indicates posterior; A, anterior. Images were acquired with a 3-T magnetic resonance imaging unit (GE Healthcare, Milwaukee, Wisconsin); postprocessing was performed with DtiStudio software.1

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