Symmetrical Central Tegmental Tract Hyperintensity on T2-weighted Images in Pediatrics: A Systematic Review

Purpose: The aim of the present study is to provide a systematic literature review of the current evidence about the Central Tegmental Tract Hyperintensity (CTTH). Methods: The literature search was performed on December 2017 using Medline PubMed, Google Scholar and Cochrane Central databases. Statistical analysis was performed using Kolmogorov-Smirnov, chi-square and the Mann-Whitney U tests. Results: Twenty publications were included. Of these, 11 were retrospective studies and 9 were case reports. In total, CTTH was reported in 226 cases. The age parameter showed a significantly non-Gaussian distribution (KS test; p-value < 0.001). The median age was 1,83 years (range: 7 days – 21 years; P25 = 1.00 year, P75 = 3.00 years; IQR =2 years). The two most common clinical conditions associated to CTTH were cerebral palsy (51 cases; 22.6%) and glutaric aciduria type 1 (50 cases; 22.10%). CTTH was often found in the absence of other concomitant brain MRI abnormalities (32 cases; 21.8%). Conclusions: CTTH is an uncommon neuroimaging finding that is mainly related to the acquisition\improvement of a physiologicalmotor developmental process. The finding is influenced by hypoxic-ischemic and toxic‐metabolic factors. Data regarding DWI and follow-up are largely unreported and deserve to be further explored.