Etiology of Corpus Callosum Lesions with Restricted Diffusion
Etiology of Corpus Callosum Lesions with Restricted Diffusion
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DOI：
10.1007/s00062-015-0409-8
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发表时间：
2017-03-01
影响因子：
2.8
通讯作者：
Messe, S. R.
中科院分区：
文献类型：
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作者：
Wilson, C. A.;Mullen, M. T.;Messe, S. R.
目的胼胝体梗死是一种罕见的疾病，其他情况可引起核磁共振成像（MRI）限制胼胝体内的扩散，导致诊断不确定。我们试图描述胼胝体扩散受限病变的病因。方法2000年1月至2010年12月在我院发现弥散受限的胼胝体病变。我们回顾了影像学和临床资料，以确定病变是否为血管性病变，如果是，则确定潜在的机制。结果共对174例病例进行了深入分析；470%为血管病变，53%为非血管病变。在血管病例中，非典型机制（例如，血管炎/血管病变，高凝状态）是最常见的（37%），其次是心脏栓塞（28%）。尤其是脾血管性病变，可能是由于非典型的中风原因。最常见的非血管病因是创伤（44%）、肿瘤（22%）和脱髓鞘（15%）。血管病变在具有血管危险因素的老年非白种人患者中更为常见。非血管性病变更可能与MRI上的t2高强度皮质病变、局灶性实质内强化或水肿/肿块效应相关。结论胼胝体扩散受限病变半数以上是由非血管原因引起的。临床和影像学特征有助于区分胼胝体的血管性和非血管性病变。非血管病变更可能出现在没有血管危险因素的年轻患者身上，并且更常伴有强化和水肿。血管病变最常见的是由于非典型中风病因，这些患者可能需要额外的诊断测试。
Purpose Infarction of the corpus callosum is rare, and other conditions can cause magnetic resonance imaging (MRI) restricted diffusion in the callosum, leading to diagnostic uncertainty. We sought to characterize the etiology of lesions with diffusion restriction in the corpus callosum.Methods Callosal lesions with restricted diffusion were identified at our institution between January 2000 and December 2010. Radiographic and clinical data were reviewed to determine whether the lesion was vascular and if so, to identify the underlying mechanism.Results A total of 174 cases were reviewed in depth; 470% were vascular and 53 % were nonvascular. Among vascular cases, atypical mechanisms of stroke (e.g., vasculitis/vasculopathy, hypercoagulable state) were most common (37 %), followed by cardioembolism (28%). Vascular splenial lesions in particular were likely due to atypical causes of stroke. The most commnon nonvascular etiologies were trauma (44 %), tumor (22 %), and demyelination (15 %). Vascular lesions were more common in older, non-Caucasian patients with vascular risk factors. Nonvascular lesions were more likely to be found in association with T2-hyperintense cortical lesions, focal intraparenchymal enhancement, or edema/mass effect on MRI.Conclusions More than half of lesions with diffusion restriction in the corpus callosum are due to a nonvascular cause. Clinical and radiographic characteristics can help distinguish vascular from nonvascular lesions in the corpus callosum. Nonvascular lesions are more likely to be seen in younger patients without vascular risk factors and are more often accompanied by enhancement and edema. Vascular lesions are most commonly due to atypical stroke etiologies, and these patients may require additional diagnostic testing.