MRI of early and advanced leukodystrophy in X-linked adrenoleukodystrophy (ALD)

Brain MRI scan of an asymptomatic 10-year-old boy with ALD, which shows a small lesion in the splenium of the corpus callosum on T2-weighted imaging (A), with contrast enhancement (B). Panels C and D show the brain MRI scan of a boy who presented with cognitive decline, caused by an extensive leukodystrophy. He was diagnosed with ALD based on clinical features and the typical pattern of MRI abnormalities; the diagnosis was confirmed by biochemical and genetic testing.