Figure 2. Associated MRI findings in patients with Cowden syndrome (CS).

(A) The classic striated appearance of Lhermitte-Duclos disease (LDD) (arrows) is well-demonstrated with T2-weighted imaging in a 67-year-old woman. (B) Axial T1 postcontrast MRI illustrates a large left parietal dural-based extra-axial mass (arrowheads), which was pathologically confirmed to represent a meningioma, in a 54-year-old woman. (C) Axial T1 postcontrast MRI demonstrates bilateral frontal developmental venous anomalies (arrows) in a 50-year-old woman. (D) Numerous foci of white matter hyperintensity (arrows), which are greater than expected for age, are identified on an axial T2-weighted fluid-attenuated inversion recovery sequence in a 39-year-old man. (E) As depicted on an axial T2-weighted sequence, multiple abnormally prominent perivascular spaces (arrows) are present in the cerebral white matter of a 61-year-old man. (F) In a 62-year-old woman, susceptibility-weighted imaging reveals multiple foci of magnetic susceptibility (arrows) in the cerebral white matter, which are presumably related to hemosiderin deposition from chronic microhemorrhages or possibly tiny cavernous malformations. (G) As seen on sagittal T1-weighted MRI, low-lying cerebellar tonsils (arrow) reach the upper aspect of the C1 arch in a 61-year-old woman who had CS without LDD. (H) In a 22-year-old woman with CS and LDD, sagittal T1-weighted image demonstrates cerebellar tonsillar ectopia (arrow) and typical striated appearance of the cerebellar gangliocytoma (asterisk). (I) Sagittal T1-weighted sequence depicts thick and irregularly bumpy cortex (arrows) consistent with a coarse pattern of right perisylvian polymicrogyria in an 8-year-old boy. A separate abnormality in the left frontal lobe had imaging features suspicious for cortical dysplasia (not shown).