MRI, with thin slice volumetric T1-weighted images, axial and coronal T2-weighted and FLAIR images.
The pathological and imaging features of cortical tubers can be indistinguishable from those of focal cortical dysplasia (FCD IIb). Hemimegalencephaly has been reported in some patients with tuberous sclerosis.
This is a T2-weighted image of a cortical tuber in an immature brain. There is a localized area of gyral expansion in the right frontal lobe, with abnormal low signal in the underlying white matter. The imaging features of this tuber can be similar to that of a focal cortical dysplasia (FCD type IIb).
Both images below are from the same patient and show:
The image below is a T2-weighted image showing cortical tubers in the right and left frontal lobes (arrows).