Comparative Evaluation of CT and MRI in Detecting Intracranial and Extracranial Manifestations of Tuberous Sclerosis Complex

Background: Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder characterized by the formation of benign tumors in multiple organs. Neuroimaging plays a pivotal role in diagnosis and surveillance of intracranial and extracranial manifestations. Objective: To evaluate and compare the diagnostic performance of CT and MRI in detecting intracranial and extracranial lesions associated with TSC. Methods: A retrospective analysis was conducted on imaging data from 57 patients diagnosed with TSC. Cranial CT and routine MRI findings were reviewed and compared. In addition, abdominal and thoracic CT findings were evaluated for renal, hepatic, pulmonary, and skeletal involvement. Results: Subependymal calcified nodules were observed in 51/57 (89.5%) patients, with a CT detection rate of 100% (46/46), significantly higher than routine MRI (68.4%, 13/19; P < 0.001). Cortical dysplasia lesions were found in 19/57 (33.3%) patients, with significant difference between CT (10/46, 21.7%) and routine MRI (16/19, 84.2%; P < 0.001). Subependymal giant cell astrocytoma (SEGA) lesions were detected in 11/19 (19.3%) cases with no statistical difference between CT (7/46, 15.2%) and routine MRI (6/19, 31.6%; P = 0.250). Cerebral fissure malformation and cranial bone dysplasia were detected in 3/57 (5.3%) and 2/57 (3.5%) patients, respectively. Extracranially, renal angiomyolipoma (AML) lesions were detected in 12/21 (57.1%) patients, hepatic AMLs in 5/21 (23.8%), multifocal micronodular pneumocyte hyperplasia (MMPH) lesions in 5/15 (33.3%), pulmonary lymphangioleiomyomatosis (LAM) lesions in 3/15 (20.0%), and multifocal bone sclerosis in 13/36 (36.1%) by CT. Conclusion: CT and routine MRI demonstrated lesion-specific, complementary roles in TSC. CT preferentially identified calcified lesions and delineated extracranial multisystem involvement, whereas MRI offered an advantage in the detection of cortical dysplasia and other soft-tissue abnormalities. Integrating intracranial and extracranial imaging within a single cohort, this study supported a practical, modality-tailored CT–MRI approach for comprehensive assessment and risk-adapted surveillance in TSC. Keywords: tuberous sclerosis complex, CT, MRI, comparative evaluation