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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticlePediatric Neuroimaging
Open Access

Incidental Thalamic Lesions Identified on Brain MRI in Pediatric and Young Adult Patients: Imaging Features and Natural History

Vinicius de Padua V. Alves, Marguerite M. Care and James L. Leach
American Journal of Neuroradiology February 2024, 45 (2) 211-217; DOI: https://doi.org/10.3174/ajnr.A8090
Vinicius de Padua V. Alves
aFrom the Department of Radiology (V.d.P.V.A., M.M.C., J.L.L.), Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Marguerite M. Care
aFrom the Department of Radiology (V.d.P.V.A., M.M.C., J.L.L.), Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
bDepartment of Radiology (M.M.C., J.L.L.), University of Cincinnati College of Medicine, Cincinnati, Ohio
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James L. Leach
aFrom the Department of Radiology (V.d.P.V.A., M.M.C., J.L.L.), Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
bDepartment of Radiology (M.M.C., J.L.L.), University of Cincinnati College of Medicine, Cincinnati, Ohio
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  • FIG 1.
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    FIG 1.

    Flow chart of study participant selection process. Conditions on right denote exclusion criteria.

  • FIG 2.
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    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.

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    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.
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    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

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    Table 1:

    Clinical scenario for baseline MR imaging examinations (n = 171)

    MR Imaging Examination Indicationn%
    Migraine headache5331
    Seizures/epilepsy4023.4
    NOS headache2011.7
    Othera1810.5
    Behavioral/developmentalb137.6
    Head injury84.7
    Movement disorder52.9
    Ophthalmologic42.3
    Psychiatric42.3
    Hearing loss31.8
    Idiopathic intracranial hypertension31.8
    • 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.

    • View popup
    Table 2:

    Thalamic lesion signal characteristics on baseline MR imaging (n = 180 lesions)

    SignalPDT1T2T2 FLAIRDWIADCGRE/SWI
    Hypointense0.026.50.00.01.80.00.0
    Isointense42.816.021.019.019.81.816.5
    Hyperintense52.41.777.379.911.153.155.3
    Not visible9.555.81.11.168.546.329.8
    • View popup
    Table 3:

    MR imaging follow-up recommendations available on baseline imaging reports (n = 171 patients)a

    Noneb1 Monthc2 Months3 Months4 Months6 Months9 Months12 MonthsNOSd
    347762441376
    • 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.

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American Journal of Neuroradiology: 45 (2)
American Journal of Neuroradiology
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1 Feb 2024
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Cite this article
Vinicius de Padua V. Alves, Marguerite M. Care, James L. Leach
Incidental Thalamic Lesions Identified on Brain MRI in Pediatric and Young Adult Patients: Imaging Features and Natural History
American Journal of Neuroradiology Feb 2024, 45 (2) 211-217; DOI: 10.3174/ajnr.A8090

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Incidental Thalamic Lesions on MRI in the Young
Vinicius de Padua V. Alves, Marguerite M. Care, James L. Leach
American Journal of Neuroradiology Feb 2024, 45 (2) 211-217; DOI: 10.3174/ajnr.A8090
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