Growth dynamics of subependymal lesions in children with tuberous sclerosis complex
Summary
Objective: Growth patterns and predictors of subependymal nodules and subependymal giant cell astrocytomas remain poorly under-characterised. The aim of this study was to assess growth patterns of subependymal lesions and investigate the predictive value of known influencing factors, such as baseline volume and age, location, mutation type, enhancement, and total number of lesions.
Methods: Brain MRIs of children with tuberous sclerosis complex were retrospectively reviewed between February and December of 2024, with growth plots generated for each patient or grouped per baseline volume. Total growth and percentage growth were analysed using univariate linear regression to assess the association with known influencing factors.
Results: Fifty-three patients were analysed, with an average radiological follow-up period of 111 months and a baseline age of 107 months. Preliminary visual assessment indicated most subependymal lesions exhibit growth over time, with a subset of lesions showing temporary stabilisation or regression. Lesion’s location the Foramen of Monro, enhancement, baseline volume and age were significant predictors of both total growth and percentage growth, while mutation variant and total number of lesions did not predict growth.
Significance: The characteristic of observed serial growth is not exclusive to subependymal giant cell astrocytomas, but can be seen in subependymal lesions of all baseline volumes, thus hinting towards the SEGA characteristics not being as exclusive as indicated by tuberous sclerosis complex standard definitions. Additionally, location and enhancement might be equally as important when assessing the risk of SEN transitioning to SEGA.