Imaging of white matter lesions
Imaging of white matter lesions
复制标题
DOI：
10.1159/000049146
复制
发表时间：
2002-01-01
影响因子：
2.9
通讯作者：
Scheltens, P
中科院分区：
文献类型：
--
作者：
Barkhof, F;Scheltens, P
磁共振成像（MRI）对于检测白色病变（WML）非常敏感，这些病变发生在脑室周围帽和带以及扩张的Virchow-Robin间隙。真正的WML最好用T2加权序列，如长TR双回波自旋回波或FLAIR（液体衰减反转恢复）;后者的优点是很容易将WML与CSF样病变分开。MRI中的异常T2信号不是特异性的，并且可以伴随组织成分的任何变化。在小血管疾病的WML检查中，磁共振血管造影可用于排除（伴随）大血管疾病，弥散加权MRI可用于识别新的缺血性病变（在既存旧WML中）。WML的鉴别诊断包括遗传性脑白质营养不良和获得性疾病。可在成年期出现的脑白质营养不良包括异染性脑白质营养不良、球样细胞脑白质营养不良、肾上腺脊髓神经病、线粒体疾病、消失的白色物质和腱性黄瘤病。这些代谢紊乱通常表现为对称性异常，可能非常弥漫，通常累及脑干和小脑。只有线粒体疾病往往是更不对称的，往往涉及灰质优先。在获得性白色疾病中，缺氧缺血性原因是迄今为止最普遍的，并且在没有进一步临床线索的情况下，甚至不需要考虑下一个最常见的疾病，即多发性硬化症（MS）。在非缺血性疾病中，MS远比血管炎、感染、中毒和创伤更常见。虽然血管炎可以模仿小血管疾病，但MS具有独特的特征，优先考虑老化大脑的生理变化，累及皮质下U纤维、胼胝体、颞叶和脑干/小脑。脊髓病变在MS中非常常见，但不发生在正常衰老或小血管疾病中。版权所有（C）2002 S. Karger AG，巴塞尔。
Magnetic resonance imaging (MRI) is very sensitive for the detection of white matter lesions (WML), which occur such as periventricular caps and bands, and from dilated Virchow-Robin spaces. Genuine WML are best seen with T2-weighted sequences such as long TR dual-echo spin-echo or FLAIR (fluid-attenuated inversion recovery); the latter has the advantage of easily separating WML from CSF-like lesions. Abnormal T2 signal in MRI is not specific, and can accompany any change in tissue composition. In the work-up of WML in small vessel disease, magnetic resonance angiography can be used to rule out (concomitant) large vessel disease, and diffusion weighted MRI to identify new ischaemic lesions (amidst pre-existing old WML). The differential diagnosis of WML includes hereditary leukodystrophies and acquired disorders. The leukodystrophies that can present in adult age include metachromatic leukodystrophy, globoid cell leukodystrophy, adrenomyeloneuropathy, mitochondria[ disorders, vanishing white matter, and cerebrotendinous xanthomatosis. These metabolic disorders typically present with symmetrical abnormalities that can be very diffuse, often with involvement of brainstem and cerebellum. Only the mitochondrial disorders tend to be more asymmetric and frequently involve the grey matter preferentially. Among the acquired white matter disorders, hypoxic-ischaemic causes are by far the most prevalent and without further clinical clues there is no need to even consider the next most common disorder, i.e. multiple sclerosis (MS). Among the nonischaemic disorders, MS is far more common than vasculitis, infection, intoxication and trauma. While vasculitis can mimic small vessel disease, MS has distinctive features with preferential rated from physiological changes in the ageing brain, involvement of the subcortical U-fibres, the corpus callosum, temporal lobes and the brainstem/cerebellum. Spinal cord lesions are very common in MS, but do not occur in normal ageing nor in small vessel disease. Copyright (C) 2002 S. Karger AG, Basel.