Magnetic resonance imaging findings in a case of advanced Coats' disease

Coats' disease is an idiopathic, primary vascular anomaly of the retina often presenting with retinal detachment. In this report, the unusual radiologic findings of a 17-month-old patient with advanced Coats' disease are discussed. Computed tomography (CT) showed diffuse increased density of the right eye. Magnetic resonance imaging (MRI) demonstrated moderately hyperintense signal intensity on T₁-weighted images, mildly hypointense signal intensity on T₂-weighted images, and linear enhancement of the leaves of the detached retina with intense enhancement in the retinal periphery following gadolinium-diethylenetriamine penta-acetic acid (DTPA) contrast administration. The hypointense T₂-weighted images and the linear enhancement of the detached retina have not been reported previously in cases of Coats' disease. These observations correlated with the histopathologic features, which showed a totally detached retina containing large telangiectatic vessels and a subretinal space occupied by eosinophilic proteinaceous exudates containing abundant cholesterol crystals. It appears that the MRI characteristics observed in Coats' disease may vary depending on the nature of the subretinal exudate and the severity of the disease.