PMC4813063_01
T1W inversion recovery images at the basal ganglia level in axial (A) and sagittal (B) planes showing peripheral hyperintense signal intensity ring (downward arrow) in bilateral lentiform nuclei around heterogeneous low signal center (upward/backward arrow)
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F1
On T1W images, bilateral putamen and globus pallidi appeared to be involved with a peripheral hyperintense signal intensity rim and central low heterogeneous signal compared to white matter [Figure 1A and B].
T2W images at the level of basal ganglia in axial (A) and coronal (B) planes showing symmetric hyperintense signal intensity in bilateral lentiform nuclei (upward arrow) with small hypointense signal area toward the center (downward arrow)
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F2
Corresponding lentiform lesions showed predominant hyperintense signal intensity on T2W images with small, slightly hypointense signal in the center [Figure 2A and B] which was more clearly seen in axial images.
Axial diffusion-weighted MRI at b value of 1000 s/mm2 (A) at the level of basal ganglia shows hyperintense signal intensity in bilateral lentiform nuclei (arrow). ADC map (B) at the same level shows reduced ADC value in bilateral lentiform nuclei seen as hypointense signal (arrow)
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F3
ADC [Figure 3B] compatible with restricted diffusion. ADC maps revealed low ADC value in the lentiform nuclei (0.9 x 10-3 mm2/s) than thalami (1.1x10-3 mm2/s).
Susceptibility-weighted axial MRI (T2**) at the level of basal ganglia shows indistinct loss of signal/blooming (arrow) in the region of lentiform nuclei which is seen as hyperintense on T1W and T2W images
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F4
No convincing blooming was noticed on SWI (T2**) images in the lentiform nuclei in the corresponding T1W- and T2W-hyperintense signal intensity lesions [Figure 4].
MRS at TE 135 ms of lentiform lesion showing elevated choline peak, reduced N-acetyl aspartate peak, and slight raised lactate level
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F5
TE = 135 ms) of the lentiform lesions revealed a non-specific appearance of reduced N-acetylaspartate NAA peak and elevated choline peak with slightly elevated lactate peak [Figure 5]. There was no other significant abnormality of cerebellum, brainstem, or cerebral cortex on MRI brain.