Central Tegmental Tract Hyperintensity on Cranial MRI in Pediatric Patients

Objective: The central tegmental tract (CTT) is an extrapyramidal pathway located in the brainstem.CTT hyperintensity (CTTH) is a neuroimaging finding of uncertain etiology, considered either part of the normal maturation process or a finding that can be seen in various neurological conditions.This study aims to investigate its relationship with age and the associated disorders of CTTH observed in the pediatric population.Method: All brain magnetic resonance imagings (MRIs) performed between July 2023 and November 2025 at a tertiary pediatric hospital were retrospectively reviewed.Eighty-one pediatric patients with CTTH were included in the study.Clinical data, additional MRI findings, and available follow-up scans were examined.Results: CTTH was detected in 1.4% of all cranial MRIs, while the median age of the cases was 17 months.The most common complaints at admission were seizures (35.8%) and developmental delay (28.4%).Additional MRI findings (most commonly periventricular leukomalacia) were observed in 51.9% of the cases.The age of patients in this group with additional MRI findings was significantly lower than those without (median ages: 15 vs. 23 months).CTTH resolved in 36.7%, and persisted in 63.3% of the patients who underwent follow-up MRI.It was determined that CTTH resolved significantly in older children compared to the persistent cases among younger patients (median: 26 vs. 14 months). Conclusion:CTTH is a finding that can be seen in pediatric cranial MRI examinations, and its clinical significance should be interpreted by considering the patients' age and associated neurological conditions.