Figure 3.

Changes in brain MRI findings. (A) Representative coronal or axial images obtained by FLAIR imaging (upper panels) and T1W imaging with Gd enhancement (lower panels) on brain MRI before and after HSCT in Patients 2, 4 and 7. In Patient 2, the white matter lesions enlarged and were Gd-enhanced before HSCT. The white matter lesions became small (upper panels) and the Gd-enhanced lesions became gradually obscure (lower panels) after HSCT. In Patient 4, the white matter lesions in the pyramidal tracts enlarged until 1.4 months after HSCT but subsequently became small (upper panels). The white matter lesions in the pyramidal tracts were Gd-enhanced before HSCT but disappeared after HSCT (lower panels). In Patient 7, the white matter lesions in the frontal, parietal, temporal and occipital lobes enlarged until 1.3 months after HSCT, but the white matter lesions subsequently became small (upper panels). The white matter lesion in the splenium of the corpus callosum was Gd-enhanced before HSCT but disappeared after HSCT (lower panels). (B) Axial FLAIR images of Patient 18 who declined to undergo HSCT. When we considered HSCT for the patient, brain MRI showed limited white matter lesions in the pyramidal tracts and mild white matter lesions in the optic radiations, the brachia of the inferior colliculus and the cerebellum (Loes score, 3.5). These white matter lesions showed progressive enlargement, and brain MRI taken 57.5 months later showed massive cerebral, cerebellar and brainstem white matter lesions accompanied with marked atrophy (Loes score, 34). FLAIR = fluid-attenuated inversion recovery; T1W = T₁ weighted.