Article Figures & Data
Figures
- FIG 1.
Flow chart of study participant selection process. Conditions on right denote exclusion criteria.
- FIG 2.
Example cases of incidental thalamic lesions identified in this study. A, Axial T2-weighted images of a 13-year-old adolescent girl with headache show a focal thalamic lesion (arrow) within the anterior lateral right thalamus on baseline MR imaging. The lesion was stable on the 3-month follow-up and resolved at 22-month follow-up. B, Axial T2-weighted images of a 9-year-old girl with headache show ill-defined thalamic signal (arrow) in the posterior right thalamus on baseline MR imaging. At 1-year follow-up, the lesion was slightly less defined and smaller. At 9-year follow-up, the lesion was smaller and less defined. This patient had 12 follow-up scans for this lesion over a 9-year period. C, Axial T2 FLAIR images of a 5-year-old girl after a single seizure episode. Baseline MR imaging shows a small focal signal abnormality in the right thalamus (arrow). This lesion slightly enlarged at 1-year follow-up and resolved at 18-month follow-up imaging.
- FIG 3.
Example cases of enlarging incidental thalamic lesions identified in this study. A, Axial T2 FLAIR images of a 6-year-old boy with headache show a focal thalamic lesion (arrow) within the posterior left thalamus on baseline MR imaging. At 13 month follow-up, the lesion was enlarged. At 46-month follow-up, the lesion was more ill-defined and slightly decreased posteriorly. B, Axial T2 FLAIR images part of routine follow-up of a 4-year-old boy with history of right cerebellar complex developmental venous anomaly. Baseline MR imaging shows a small focus of increased signal in the posterior right thalamus, enlarged at 13-month follow-up, then stable 52 months after baseline MRI. C, Axial T2-weighted images of an 8-year-old girl with history of head trauma and headache showing a focal lesion within the left medial thalamus (7 × 5 mm). There was slow interval enlargement over 5 MR imaging studies for 19 months, at which point the lesion was classified as presumed low-grade glioma, and was treated with a total of 50.4 Gy fractionated radiation therapy over 8 weeks. Following therapy, there was a decrease in the site over subsequent 34 months.
- FIG 4.
Growth trajectories of 9 thalamic lesions that enlarged at any time during follow-up MR imaging. Patient D, an 8-year-old girl with history of head trauma and headache, was treated with radiation therapy 19 months after initial lesion identification after growth identified with a subsequent decrease in size. Patient B, a 14-year-old adolescent boy with history of fetal alcohol syndrome and tethered cord, had additional stable follow-up examinations at 138 and 190 months (not shown).
Tables
MR Imaging Examination Indication n % Migraine headache 53 31 Seizures/epilepsy 40 23.4 NOS headache 20 11.7 Othera 18 10.5 Behavioral/developmentalb 13 7.6 Head injury 8 4.7 Movement disorder 5 2.9 Ophthalmologic 4 2.3 Psychiatric 4 2.3 Hearing loss 3 1.8 Idiopathic intracranial hypertension 3 1.8 Note:— NOS indicates not otherwise specified.
↵a Includes precocious puberty, hypopituitarism, central sleep apnea or congenital central hypoventilation, focal neurologic findings, Fanconi anemia, lymphoma, Li-Fraumeni syndrome screening, unspecified neck pain, Chiari syndrome, syncope, prior stroke, and vertigo.
↵b Includes attention deficit/hyperactivity disorder, autism spectrum disorder, fine and gross motor delay, intermittent explosive disorder, and language delay.
Signal PD T1 T2 T2 FLAIR DWI ADC GRE/SWI Hypointense 0.0 26.5 0.0 0.0 1.8 0.0 0.0 Isointense 42.8 16.0 21.0 19.0 19.8 1.8 16.5 Hyperintense 52.4 1.7 77.3 79.9 11.1 53.1 55.3 Not visible 9.5 55.8 1.1 1.1 68.5 46.3 29.8 - Table 3:
MR imaging follow-up recommendations available on baseline imaging reports (n = 171 patients)a
Noneb 1 Monthc 2 Months 3 Months 4 Months 6 Months 9 Months 12 Months NOSd 3 4 7 76 24 41 3 7 6 Note:— NOS indicates not otherwise specified.
↵a Values are absolute numbers.
↵b Study report did not provide recommendations for follow-up imaging.
↵c In the case an interval range of follow-up was given, the smallest interval was considered.
↵d Imaging follow-up was recommended but no specified time interval.
