Corpus callosum: Normal imaging appearance, variants and pathologic conditions (original) (raw)

Abstract

Various types of lesions can occur within the corpus callosum (CC) which is a white matter tract communicating corresponding regions of the cerebral hemispheres. Magnetic resonance imaging is the modality of choice for the evaluation of the CC. In addition, diffusion weighted imaging and diffusion tensor imaging can provide additional information about the CC. The aim of this study is to illustrate the imaging features of the corpus callosum and its pathologies. . As a consequence of the order of formation, in dysgenesis, the splenium and rostrum are always missing ). 1-3

Figures (15)

Fig. 2. Agenesis of the CC. Sagittal T1-weighted (a) and axial DT (b) MR images show complete absence of the CC accompanied by the presence of Probs bundles (arrows). Approximately one-third of all intracranial lipomas arise in the pericallosal region. Depending on their size, either partial or complete agenesis of the CC is present in over 50% of cases with pericallosal lipoma.° Lipomas of the CC are classically seen as well-marginated masses showing same signal intensities with fat tissue in all MR sequences (Fig. 5).

Fig. 2. Agenesis of the CC. Sagittal T1-weighted (a) and axial DT (b) MR images show complete absence of the CC accompanied by the presence of Probs bundles (arrows). Approximately one-third of all intracranial lipomas arise in the pericallosal region. Depending on their size, either partial or complete agenesis of the CC is present in over 50% of cases with pericallosal lipoma.° Lipomas of the CC are classically seen as well-marginated masses showing same signal intensities with fat tissue in all MR sequences (Fig. 5).

Fig. 1. Normal appearance of the corpus callosum (CC) in 6-year-old boy. Sag: ittal T1-weighted (a) and axial diffusion tensor (DT) (6) MR images show the normal CC (R = rostrum, G = genu, C = corpus, S = splenium).

Fig. 1. Normal appearance of the corpus callosum (CC) in 6-year-old boy. Sag: ittal T1-weighted (a) and axial diffusion tensor (DT) (6) MR images show the normal CC (R = rostrum, G = genu, C = corpus, S = splenium).

Fig. 3. 2-year-old boy with dysgenesis of the CC. Sagittal T1-weighted image shows absence of the entire CC, but the genu (arrow).

Fig. 3. 2-year-old boy with dysgenesis of the CC. Sagittal T1-weighted image shows absence of the entire CC, but the genu (arrow).

Fig. 4. 2-year old boy with type 2b interhemispheric cyst. Axial (a) and sagittal (b) T1- weighted images demonstrate absence of the posterior body, splenium and rostrum of the CC, and loculated interhemispheric cyst (white arrows) with higher signal intensity in the posterior portion. Right posterior and periven- tricular gray matter heterotopia areas can be also seen (black arrows). The mucopolysaccharidoses lead to the accumula- tion of glycosaminoglycans in many tissues, such as brain parenchyma. Enlarged perivascular spaces can be prominent in healthy individuals. However, during the natural course of mucopolysaccharidoses, the formation

Fig. 4. 2-year old boy with type 2b interhemispheric cyst. Axial (a) and sagittal (b) T1- weighted images demonstrate absence of the posterior body, splenium and rostrum of the CC, and loculated interhemispheric cyst (white arrows) with higher signal intensity in the posterior portion. Right posterior and periven- tricular gray matter heterotopia areas can be also seen (black arrows). The mucopolysaccharidoses lead to the accumula- tion of glycosaminoglycans in many tissues, such as brain parenchyma. Enlarged perivascular spaces can be prominent in healthy individuals. However, during the natural course of mucopolysaccharidoses, the formation

Fig. 6. 2-year-old girl with syntelencephaly. Sagittal (a) and coronal (b) T1-weighted MR images demonstrate fusion of the cerebral hemispheres across the midline and partial agenesis of the CC.

Fig. 6. 2-year-old girl with syntelencephaly. Sagittal (a) and coronal (b) T1-weighted MR images demonstrate fusion of the cerebral hemispheres across the midline and partial agenesis of the CC.

Fig. 5. 27-year-old woman with pericallosal lipoma. Sagittal T1-weighted image demonstrates a high intensity, linear mass (arrows), adjacent to the CC.

Fig. 5. 27-year-old woman with pericallosal lipoma. Sagittal T1-weighted image demonstrates a high intensity, linear mass (arrows), adjacent to the CC.

Fig. 7. Biochemically and genetically proven adrenoleukodystrophy in an 11-year-old boy. Sagittal T1-weighted image (a) demonstrates low signal inten- sity in the splenium of the CC (arrow). Axial T2-weighted image (b) shows very intense signals within the entire white matter of both parieto-occipital lobes extending into the posterior part of internal capsules, thalamus and splenium of the CC (arrow).

Fig. 7. Biochemically and genetically proven adrenoleukodystrophy in an 11-year-old boy. Sagittal T1-weighted image (a) demonstrates low signal inten- sity in the splenium of the CC (arrow). Axial T2-weighted image (b) shows very intense signals within the entire white matter of both parieto-occipital lobes extending into the posterior part of internal capsules, thalamus and splenium of the CC (arrow).

Fig. 8. 1-year old boy with mucopolysaccharidosis (Hurler syndrome) proven by clinical examination, urine tests and enzyme assays. Sagittal (a) and axial (b) T1-weighted images demonstrate involvement of the CC and periventricular white matter by dilated perivascular spaces. CC may be traumatised by surgical procedures such as tumour surgery or therapeutic callosotomy. In some cases, seizures may spread from one hemisphere to the other through the CC. Corpus callosotomy may be

Fig. 8. 1-year old boy with mucopolysaccharidosis (Hurler syndrome) proven by clinical examination, urine tests and enzyme assays. Sagittal (a) and axial (b) T1-weighted images demonstrate involvement of the CC and periventricular white matter by dilated perivascular spaces. CC may be traumatised by surgical procedures such as tumour surgery or therapeutic callosotomy. In some cases, seizures may spread from one hemisphere to the other through the CC. Corpus callosotomy may be

Fig. 10. 33-year-old woman with clinically and radiologically proven multiple sclerosis. Sagittal FLAIR image shows multiple hyperintense lesions in the CC and callosal-septal interface.

Fig. 10. 33-year-old woman with clinically and radiologically proven multiple sclerosis. Sagittal FLAIR image shows multiple hyperintense lesions in the CC and callosal-septal interface.

Fig. 11. 21-year-old man with clinically and radiologically proven acute dis- seminated encephalomyelitis. Sagittal FLAIR image shows focal hyperintense areas in rostrum, genu and anterior body, and diffuse hyperintensity in poste- rior body and splenium of the CC. Diffuse axonal injury (DAI) is a frequent cause of impaired clinical outcome in patients with traumatic brain injury. The location and severity of traumatic

Fig. 11. 21-year-old man with clinically and radiologically proven acute dis- seminated encephalomyelitis. Sagittal FLAIR image shows focal hyperintense areas in rostrum, genu and anterior body, and diffuse hyperintensity in poste- rior body and splenium of the CC. Diffuse axonal injury (DAI) is a frequent cause of impaired clinical outcome in patients with traumatic brain injury. The location and severity of traumatic

Fig. 9. 2-year old boy with periventricular leucomalacia. Axial fluid atte- nuated inversion recovery (FLAIR) image (a) shows bilateral symme- trical periventricular hyperintensities consistent with periventricular leucomalacia. Sagittal T1-weighted image (b) shows gross atrophy of the CC (arrows).

Fig. 9. 2-year old boy with periventricular leucomalacia. Axial fluid atte- nuated inversion recovery (FLAIR) image (a) shows bilateral symme- trical periventricular hyperintensities consistent with periventricular leucomalacia. Sagittal T1-weighted image (b) shows gross atrophy of the CC (arrows).

Fig. 13. 30-year-old man with diffuse axonal injury. Axial gradient echo (GE) T2-weighted image shows non-hemorrhagic hyperintense (black arrow) and hemorrhagic hypointense (white arrows) lesions in the CC. Subdural hematoma overlying the left frontal lobe can be also seen (white arrowheads). Vascular malformations such as cavernomas and arte- riovenous malformation (AVMs) may also involve the CC and have the same appearance with the ones located in any part of the central nervous system other than CC (Fig. 15).

Fig. 13. 30-year-old man with diffuse axonal injury. Axial gradient echo (GE) T2-weighted image shows non-hemorrhagic hyperintense (black arrow) and hemorrhagic hypointense (white arrows) lesions in the CC. Subdural hematoma overlying the left frontal lobe can be also seen (white arrowheads). Vascular malformations such as cavernomas and arte- riovenous malformation (AVMs) may also involve the CC and have the same appearance with the ones located in any part of the central nervous system other than CC (Fig. 15).

Fig. 12. 68-year old man with histopathologically proven glioblastoma multi- forme. Sagittal T1-weighted (a), and axial T2-weighted (b) images demonstrate expansile lesion in the splenium (arrow) of the CC with extension into both cerebral hemispheres and moderate peritumoural oedema.

Fig. 12. 68-year old man with histopathologically proven glioblastoma multi- forme. Sagittal T1-weighted (a), and axial T2-weighted (b) images demonstrate expansile lesion in the splenium (arrow) of the CC with extension into both cerebral hemispheres and moderate peritumoural oedema.

Fig. 14. Transient signal changes in a 22-year old man with acute Carbamazepine withdrawal. Axial FLAIR (a), diffusion trace (b = 1000 s/mm?) (b), and correspond- ing ADC map (c) images show a well-defined circumscribed splenial lesion (arrow), that is hyperintense on FLAIR and diffusion trace images. On ADC map image restricted diffusion is seen in the lesion. Signal changes recovered in three weeks.

Fig. 14. Transient signal changes in a 22-year old man with acute Carbamazepine withdrawal. Axial FLAIR (a), diffusion trace (b = 1000 s/mm?) (b), and correspond- ing ADC map (c) images show a well-defined circumscribed splenial lesion (arrow), that is hyperintense on FLAIR and diffusion trace images. On ADC map image restricted diffusion is seen in the lesion. Signal changes recovered in three weeks.

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