Periventricular Leukomalacia: Comparison of Parenchymal Signal and Volume Changes on Brain MRI in Paediatric Cases with Healthy Peers

Background/aims: Previous MRI studies have shown white matter (WM) and gray matter (GM) of cerebrum and cerebellum, corpus callosum (CC) abnormalities in periventricular leukomalacia (PVL). But, the WM FLAIR signal ratio in MRI may provide quantitative data in the diagnosis and follow-up, as a new radiologic method. Thalamic involvement may be a biomarker for neuronal damage and disease severity. We aimed to re-investigate both WM and GM volume changes of cerebrum and cerebellum, CC surface area in PVL, and to evaluate the diagnostic accuracy of the thalamus L sign and FLAIR signal ratio. Methods: MRI scans of 30 pediatric patients with PVL and 42 healthy controls were analyzed to examine WM and GM volume changes, FLAIR signal ratio, CC surface area, and thalamus L sign. Volumetric analyses were done with the Volbrain program. Results: Decreased subcortical GM volumes were found in PVL (p<0.001). There was a significant positive correlation between FLAIR signal ratio, various GM and cerebellum volumes. In patients with thalamus L sign, decreased GM volume and increased abnormal signaled WM volume were observed. The most important variable in the diagnosis of PVL was abnormally signaled WM volume (p>0.001). Conclusions: Our results emphasise the role of MRI in the detection of PVL, the evaluation of GM changes and brain damage, and the importance of thalamus L sign and FLAIR signal ratio in the evaluation of the severity of the disease. Comprehensive studies in this direction may contribute to the development of targeted treatment strategies aimed at reducing cognitive and motor impairments in PVL.