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Loeys-Dietz syndrome: cardiovascular, neuroradiological and musculoskeletal imaging findings

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Abstract

Loeys-Dietz syndrome (LDS) is an increasingly recognized autosomal-dominant connective tissue disorder with distinctive radiological manifestations, including arterial tortuosity/aneurysms, craniofacial malformations and skeletal abnormalities. LDS exhibits a more aggressive course than similar disorders, such as Marfan or the vascular subtype of Ehlers-Danlos syndrome, with morbidity and mortality typically resulting from complications of aortic/arterial dissections. Early diagnosis, short-interval follow-up imaging and prophylactic surgical intervention are essential in preventing catastrophic cardiovascular complications. This review focuses on the cardiovascular, neuroradiological and musculoskeletal imaging findings in this disorder and recommendations for follow-up imaging.

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References

  1. Loeys BL, Chen J, Neptune ER et al (2005) A syndrome of altered cardiovascular, craniofacial, neurocognitive and skeletal development caused by mutations in TGFBR1 or TGFBR2. Nat Genet 37:275–281

    Article  PubMed  CAS  Google Scholar 

  2. Gutman G, Baris HN, Hirsch R et al (2009) Loeys-Dietz syndrome in pregnancy: a case description and report of a novel mutation. Fetal Diagn Ther 26:35–37

    Article  PubMed  Google Scholar 

  3. Sousa SB, Lambot-Juhan K, Rio M et al (2011) Expanding the skeletal phenotype of Loeys-Dietz syndrome. Am J Med Genet A 155:1178–1183

    Article  Google Scholar 

  4. Mizuguchi T, Matsumoto N (2007) Recent progress in genetics of Marfan syndrome and Marfan-associated disorders. J Hum Genet 52:1–12

    Article  PubMed  CAS  Google Scholar 

  5. Arslan-Kirchner M, Epplen JT, Faivre L et al (2011) Clinical utility gene card for: Loeys-Dietz syndrome (TGFBR1/2) and related phenotypes. Eur J Hum Genet. doi:10.1038/ejhg.2011.68

  6. Yetman AT, Beroukhim RS, Ivy DD et al (2007) Importance of the clinical recognition of Loeys-Dietz syndrome in the neonatal period. Pediatrics 119:1199–1202

    Article  Google Scholar 

  7. NCBI (2011) TGFBR1 transforming growth factor, beta receptor 1 (Homo sapiens). http://www.ncbi.nlm.nih.gov/gene/7046. Accessed 28 March 2011

  8. NCBI (2011) TGFBR2 transforming growth factor, beta receptor II (70/80 kDa) (Homo sapiens). http://www.ncbi.nlm.nih.gov/gene/7048. Accessed 28 March 2011

  9. Breckpot J, Budts W, De Zegher F et al (2010) Duplication of the TGFBR1 gene causes features of Loeys-Dietz syndrome. Eur J Hum Genet 53:408–410

    Google Scholar 

  10. Watanabe Y, Sakai H, Nishimura A et al (2008) Paternal somatic mosaicism of a TGFBR2 mutation transmitting to an affected son with Loeys-Dietz syndrome. Am J Med Genet A 146A:3070–3074

    Article  PubMed  CAS  Google Scholar 

  11. Cohen MM (2003) TGF/Smad signaling system and its pathologic correlates. Am J Med Genet A 116:1–10

    Article  Google Scholar 

  12. Horbelt D, Guo G, Robinson PN et al (2010) Quantitative analysis of TGFBR2 mutations in Marfan-syndrome-related disorders suggests a correlation between phenotypic severity and Smad signaling activity. J Cell Sci 120:4340–4350

    Article  Google Scholar 

  13. Pepper MS (1997) Transforming growth factor-beta: vasculogenesis, angiogenesis, and vessel wall integrity. Cytokine Growth Factor Rev 8:21–43

    Article  PubMed  CAS  Google Scholar 

  14. Bartram U, Molin DGM, Wisse LJ et al (2001) Double-outlet right ventricle and overriding tricuspid valve reflect disturbances of looping, myocardialization, endocardial cushion differentiation, and apoptosis in TGF-beta(2)-knockout mice. Circulation 103:2745–2752

    PubMed  CAS  Google Scholar 

  15. Arthur HM, Bamforth SD (2011) TGFβ signaling and congenital heart disease: insights from mouse studies. Birth Defects Res A. doi:10.1002/bdra.2079

  16. Oshima M, Oshima H, Taketo MM (1996) TGF-beta receptor type II deficiency results in defects of yolk sac hematopoiesis and vasculogenesis. Dev Biol 179:297–302

    Article  PubMed  CAS  Google Scholar 

  17. Roth DA, Gold LI, Han VKM et al (1997) Immunolocalization of transforming growth factor beta 1, beta 2, and beta 3 and insulin-like growth factor I in premature cranial suture fusion. Plast Reconstr Surg 99:300–316

    Article  PubMed  CAS  Google Scholar 

  18. Maleszewski JJ, Miller DV, Lu J et al (2009) Histopathologic findings in ascending aortas from individuals with Loeys-Dietz syndrome (LDS). Am J Surg Path 33:194–201

    Article  PubMed  Google Scholar 

  19. Kaartinen V, Warburton D (2003) Fibrillin controls TGF-beta activation. Nat Genet 33:331–332

    Article  PubMed  CAS  Google Scholar 

  20. Loeys BL, Schwarze U, Holm T et al (2006) Aneurysm syndromes caused by mutations in the TGF-beta receptor. N Engl J Med 355:788–798

    Article  PubMed  CAS  Google Scholar 

  21. Kasuya H, Weir B, Shen Y et al (1993) Procollagen types I and III and transforming growth factor-beta gene expression in the arterial wall after exposure to periarterial blood. Neurosurgery 33:716–722

    Article  PubMed  CAS  Google Scholar 

  22. Superti-Furga A, Steinmann B, Ramirez F et al (1989) Molecular defects of type III procollagen in Ehlers-Danlos syndrome type IV. Hum Genet 82:104–108

    Article  PubMed  CAS  Google Scholar 

  23. McAllister K, Grogg K, Johnson DW et al (1994) Endoglin, a TGF-beta binding protein of endothelial cells, is the gene for hereditary haemorrhagic telangiectasia type 1. Nat Genet 8:345–351

    Article  PubMed  CAS  Google Scholar 

  24. Janssens K, Vanhoenacker F, Bonduelle M et al (2006) Camurati-Engelmann disease: review of the clinical, radiological, and molecular data of 24 families and implications for diagnosis and treatment. J Med Genet 43:1–11

    Article  PubMed  CAS  Google Scholar 

  25. Andrabi S, Bekheirnia MR, Robbins-Furman P et al (2011) SMAD4 mutation segregating in a family with juvenile polyposis, aortopathy, and mitral valve dysfunction. Am J Med Genet A 155:1165–1169

    Article  CAS  Google Scholar 

  26. Lloyd BM, Braverman AC, Anadkat MJ (2011) Multiple facial milia in patients with Loeys-Dietz syndrome. Arch Dermatol 147:223–226

    Article  PubMed  Google Scholar 

  27. Viassolo V, Lituania M, Marasini M et al (2006) Fetal aortic root dilation: a prenatal feature of the Loeys Dietz syndrome. Prenat Diagn 26:1081–1083

    Article  PubMed  Google Scholar 

  28. Muramatsu Y, Kosho T, Magota M et al (2010) Progressive aortic root and pulmonary artery aneurysms in a neonate with Loeys-Dietz syndrome type 1B. Am J Med Genet A 152A:417–421

    Article  PubMed  CAS  Google Scholar 

  29. Malhotra A, Westesson PL (2009) Loeys-Dietz syndrome. Pediatr Radiol 39:1015–1015

    Article  PubMed  Google Scholar 

  30. Johnson PT, Chen JK, Loeys BL et al (2007) Loeys-Dietz syndrome: MDCT angiography findings. AJR 189:W29–W35

    Article  PubMed  Google Scholar 

  31. Rodrigues V, Elsayed S, Loeys B et al (2009) Neuroradiologic manifestations of Loeys-Dietz syndrome type 1. AJNR 30:1614–1619

    Article  PubMed  CAS  Google Scholar 

  32. Williams JA, Loeys BL, Nwakanma LU et al (2007) Early surgical experience with Loeys-Dietz: a new syndrome of aggressive thoracic aortic aneurysm disease. Ann Thorac Surg 83:S757–S763

    Article  PubMed  Google Scholar 

  33. Kono AK, Higashi M, Morisaki H et al (2010) High prevalence of vertebral artery tortuosity of Loeys-Dietz syndrome in comparison with Marfan syndrome. Jpn J Radiol 28:273–277

    Article  PubMed  CAS  Google Scholar 

  34. Erkula G, Sponseller PD, Paulsen LC et al (2010) Musculoskeletal findings of Loeys-Dietz syndrome. J Bone Joint Surg Am 92:1876–1883

    Article  PubMed  Google Scholar 

  35. Söylen B, Singh K, Abuzainin A et al (2009) Prevalence of dural ectasia in 63 gene-mutation-positive patients with features of Marfan syndrome type 1 and Loeys-Dietz syndrome and report of 22 novel FBN1 mutations. Clin Genet 75:265–270

    Article  PubMed  Google Scholar 

  36. Kirmani S, Tebben PJ, Lteif AN et al (2010) Germline TGF receptor mutations and skeletal fragility: a report on two patients with Loeys-Dietz syndrome. Am J Med Genet A 152:1016–1019

    Google Scholar 

  37. Loeys BL, Dietz HC, Braverman AC et al (2010) The revised Ghent nosology for the Marfan syndrome. J Med Genet 47:476–485

    Article  PubMed  CAS  Google Scholar 

  38. Loeys BL, Dietz HC (Last updated 29 April 2008) Loeys-Dietz syndrome. In: GeneReviews at GeneTests: medical genetics information resource (database online). Copyright, University of Washington, Seattle. 1997–2011. Available at http://www.genetests.org. Accessed 23 May 2011

  39. Pepin MG, Byers PH (Last updated 3 May 2011) Ehlers-Danlos syndrome, vascular type. In: GeneReviews at GeneTests: medical genetics information resource (database online). Copyright, University of Washington, Seattle. 1997–2011. Available at http://www.genetests.org. Accessed 24 May 2011

  40. Greally MT, Carey JC, Milewicz DM et al (1998) Shprintzen-Goldberg syndrome: a clinical analysis. Am J Med Genet 76:202–212

    Article  PubMed  CAS  Google Scholar 

  41. Greally MT (2010) Shprintzen-Goldberg syndrome. In: Pagon RA, Bird TD, Dolan DR et al (eds) GeneReviews. University of Washington, Seattle

    Google Scholar 

  42. Robinson PN, Neumann LM, Tinschert S (2006) Response to Kosaki et al Molecular pathology of Shprintzen-Goldberg syndrome. Am J Med Genet 140A:109–110

    Article  Google Scholar 

  43. Pepin M, Schwarze U, Superti-Furga A et al (2000) Clinical and genetic features of Ehlers-Danlos syndrome type IV, the vascular type. N Engl J Med 342:673–680

    Article  PubMed  CAS  Google Scholar 

  44. North KN, Whiteman DAH, Pepin MG et al (1995) Cerebrovascular complications in Ehlers Danlos syndrome type IV. Ann Neurol 38:960–964

    Article  PubMed  CAS  Google Scholar 

  45. Milewicz DM, Regalado E (Last updated 11 Jan 2011) Thoracic aortic aneurysms and aortic dissections. In: GeneReviews at GeneTests: medical genetics information resource (database online). Copyright, University of Washington, Seattle. 1997–2011. Available at http://www.genetests.org. Accessed 23 May 2011

  46. Law C, Bunyan D, Castle B et al (2006) Clinical features in a family with an R460H mutation in transforming growth factor beta receptor 2 gene. J Med Genet 43:908–916

    Article  PubMed  CAS  Google Scholar 

  47. Pannu H, Fadulu VT, Chang J et al (2005) Mutations in transforming growth factor-beta receptor type II cause familial thoracic aortic aneurysms and dissections. Circulation 112:513–520

    Article  PubMed  CAS  Google Scholar 

  48. Tran-Fadulu V, Pannu H, Kim DH et al (2009) Analysis of multigenerational families with thoracic aortic aneurysms and dissections due to TGFBR1 or TGFBR2 mutations. J Med Genet 46:607–613

    Article  PubMed  CAS  Google Scholar 

  49. Guo DC, Pannu H, Tran-Fadulu V et al (2007) Mutations in smooth muscle alpha-actin (ACTA2) lead to thoracic aortic aneurysms and dissections. Nat Genet 39:1488–1493

    Article  PubMed  CAS  Google Scholar 

  50. Gupta PA, Wallis DD, Chin TO et al (2004) FBN2 mutation associated with manifestations of Marfan syndrome and congenital contractural arachnodactyly. J Med Genet 41:e56

    Article  PubMed  CAS  Google Scholar 

  51. Van de Laar I, Oldenburg RA, Pals G et al (2011) Mutations in SMAD3 cause a syndromic form of aortic aneurysms and dissections with early-onset osteoarthritis. Nat Genet 43:121–126

    Article  PubMed  Google Scholar 

  52. Coucke PJ, Willaert A, Wessels MW et al (2006) Mutations in the facilitative glucose transporter GLUT10 alter angiogenesis and cause arterial tortuosity syndrome. Nat Genet 38:452–457

    Article  PubMed  CAS  Google Scholar 

  53. Choo J, Tan T, Lai A et al (2009) Loeys-Dietz syndrome: a Marfan-like syndrome associated with aggressive vasculopathy. Singapore Med J 50:e353–e357

    PubMed  CAS  Google Scholar 

  54. Möberg K, De Nobele S, Devos D et al (2011) The Ghent Marfan trial—a randomized, double-blind placebo controlled trial with losartan in Marfan patients treated with β-blockers. Int J Cardiol. doi:10.1016/j.ijcard.2010.12.070

  55. Barnett CP, Chitayat D, Bradley TJ et al (2011) Dexamethasone normalizes aberrant elastic fiber production and collagen 1 secretion by Loeys-Dietz syndrome fibroblasts: a possible treatment? Eur J Hum Genet 19:624–633

    Article  PubMed  CAS  Google Scholar 

  56. Valverde I, Simpson J, Beerbaum P (2006) Magnetic resonance imaging findings in Loeys-Dietz syndrome. Cardiol Young 20:210–213

    Article  Google Scholar 

  57. Attias D, Stheneur C, Roy C et al (2009) Comparison of clinical presentations and outcomes between patients with TGFBR2 and FBN1 mutations in Marfan syndrome and related disorders. Circulation 120:2541–2549

    Article  PubMed  CAS  Google Scholar 

  58. Augoustides JGT, Plappert T, Bavaria JE (2009) Aortic decision-making in the Loeys-Dietz syndrome: aortic root aneurysm and a normal-caliber ascending aorta and aortic arch. J Thorac Cardiovasc Surg 138:502–503

    Article  PubMed  Google Scholar 

  59. Oderich GS, Panneton JM, Bower TC et al (2005) The spectrum, management and clinical outcome of Ehlers-Danlos syndrome type IV: a 30-year experience. J Vasc Surg 42:98–106

    Article  PubMed  Google Scholar 

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Acknowledgement

We would like to thank Catherine Camputaro for her assistance with the 3-D reconstructions.

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Correspondence to John W. Gilbert.

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Kalra, V.B., Gilbert, J.W. & Malhotra, A. Loeys-Dietz syndrome: cardiovascular, neuroradiological and musculoskeletal imaging findings. Pediatr Radiol 41, 1495–1504 (2011). https://doi.org/10.1007/s00247-011-2195-z

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  • DOI: https://doi.org/10.1007/s00247-011-2195-z

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