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Original research article


Revisiting magnetic resonance imaging pattern of Krabbe disease–Lessons from an Indian cohort

Karthik Muthusamy1Sniya Valsa Sudhakar2Maya Thomas1Sangeetha Yoganathan1Christhunesa S. Christudass1Mahalakshmi Chandran1Hirenkumar Panwala2Sridhar Gibikote2
1Departments of Neurological Sciences, 2and Radiodiagnosis, Christian Medical College, Vellore, Tamil Nadu, India.
Date of Submission: 28-Dec-2018, Date of Acceptance: 21-Feb-2019, Date of Web Publication: 28-May-2019.
Corresponding Author:
Corresponding Author

Dr. Sniya Valsa Sudhakar

E-mail: sniya.sudhakar@gmail.com

Corresponding Author:
Corresponding Author

Dr. Sniya Valsa Sudhakar

E-mail: sniya.sudhakar@gmail.com

DOI: 10.25259/JCIS-18-2019 Facebook Twitter Google Linkedin

ABSTRACT



Context: Krabbe disease shows considerable heterogeneity in clinical features and disease progression. Imaging phenotypes are equally heterogeneous but show distinct age-based patterns. It is important for radiologists to be familiar with the imaging spectrum to substantially contribute toward early diagnosis, prognostication, and therapeutic decisions.
Aims: The study aims to describe different magnetic resonance imaging (MRI) patterns observed in a cohort of children with Krabbe disease and to assess correlation with age-based clinical phenotypes.
Materials and Methods: This is a retrospective descriptive study done at the Departments of Radiodiagnosis and Neurological Sciences of our institution, a tertiary care hospital in Southern India. Imaging features of children diagnosed with Krabbe disease over a 10-year period (2009–2018) were collected and analyzed.
Results: A total of 38 MRI brain studies from 27 patients were analyzed. Four distinct MRI patterns were recognizable among the different clinical subtypes. All patients from the early and late infantile group showed deep cerebral and cerebellar white matter and dentate hilum involvement. Optic nerve thickening was, however, more common in the former group. Adult-onset subtype showed isolated involvement of corticospinal tract, posterior periventricular white matter, and callosal splenium with the absence of other supra- and infra-tentorial findings. Juvenile subgroup showed heterogeneous mixed pattern with 78% showing adult subtype pattern and 22% showing patchy involvement of deep cerebral white matter with dentate hilum signal changes.
Conclusion: Krabbe disease shows distinct imaging features which correspond to different clinical age-based subtypes. This article reemphasizes these distinct imaging phenotypes, highlights a novel imaging appearance in juvenile Krabbe, and also alludes to the rare variant of saposin deficiency. Awareness of these patterns is essential in suggesting the appropriate diagnosis and guiding conclusive diagnostic workup. Large multicenter longitudinal studies are needed to further define the role of imaging in predicting the clinical course and thus to guide therapeutic options.
Keywords: Dentate hilum, Krabbe disease, Magnetic resonance imaging, Optic nerve hypertrophy, Tigroid pattern

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