White Matter Lesions in Adults – a Differential Diagnostic Approach

Abstract

Objective Cerebral white matter lesions on MRI in adults are a common finding. On the one hand, they may correspond to a clinically incidental feature, be physiologically or age-associated, or on the other hand they may be the overture to a severe neurological disease. With regard to pathophysiological aspects, practical hints for the differential diagnostic interpretation of lesions in daily clinical practice are presented. Material and Methods With special regard to the vascular architecture and supply of the cerebral white matter, physiological structures are schematically represented and pathophysiological processes are highlighted by comparative image analysis of equally angulated MR sequences. Results The most frequent vascular, inflammatory, metabolic, and neoplastic disease entities are presented on the basis of characteristic imaging findings and corresponding clinical- neurological constellations. The details of signal intensities and localization essential for differential diagnosis are highlighted. Conclusion By means of comparative image analysis and the recognition of characteristic lesion patterns, taking into account anatomical principles and pathophysiological processes, the differential diagnostic classification of cerebral white matter lesions and associated diseases can be significantly facilitated. The additional consideration of clinical and laboratory findings is essential. Key Points: Citation Format

Influence of Alzheimer’s disease related neuropathology on local microenvironment gene expression in the human inferior temporal cortex

“…Cerebral amyloid plaques are rarely found in white matter (118), but our finding suggests that the Aβ deposits may pertain to vascular Aβ localized in capillaries and blood vessels (119)(120)(121)(122). It would be interesting to investigate these subcortical Aβ-associated vascular microenvironments, given their putative contribution in white matter hyperintensity and cerebrovascular dysfunction in AD (123)(124)(125)(126)(127)(128). Second, while our categorical pathology classification approach allowed us to identify DEGs associated with different pathological microenvironments, we acknowledge it may not address the full spatial heterogeneity of AD pathology, and in the future, more complex modeling approaches could be implemented.…”

Characterization of MRI White Matter Signal Abnormalities in the Pediatric Population

“…One important take-away that they discuss for all incidental findings holds true for non-specific WMSAs as well: image resolution (signal to noise ratio, spatial resolution) seems to play an important role with regard to reported rates. In addition, layer gaps in 2D as opposed to 3D images can result in smaller lesions being missed [5]. Whether or not these supposably "non-specific" findings could still be related to certain pathologies remains a matter of debate.…”

“…Magnetic resonance imaging (MRI) is widely used for the identification of white matter pathologies with the presence of visible white matter signal abnormalities (WMSAs). Signals from standard imaging sequences, such as T2-weighted (T2W), T1-weighted (T1W), and fluid-attenuated inversion recovery (FLAIR) can be used to evaluate their patterns [1][2][3][4][5][6]. The spectrum of underlying pathologies itself is broad [7].…”

U-fiber analysis: a toolbox for automated quantification of U-fibers and white matter hyperintensities

“…Several studies have shown that lesions of U-fibers can help to distinguish between WM disease of presumed vascular origin and demyelinating WM disease ( 12 , 28 ). In T2-weighted fluid-attenuated inversion recovery (T2 FLAIR) images of patients with demyelinating WM disease, WM hyperintensities (WMHs) are commonly observed involving U-fibers and may cause changes in the dMRI properties of U-fibers ( 11 , 29 , 30 ). However, in those WM diseases of presumed vascular origin, WMHs generally do not involve U-fibers due to the presence of blood supply compensation and the relative absence of damage to U-fibers ( 8 , 12 , 31 ).…”