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:
-
Cerebral white matter lesions can be a harmless secondary finding or overture to a
severe neurological disease.
-
The comparative image analysis of different sequences with identical angulation is
crucial.
-
With special regard to the vascular anatomy, different lesion patterns can be identified.
-
The consideration of neurological and laboratory chemical constellations is essential
for the differential diagnosis.
Citation Format
Key words
white matter lesion - MRI - differential diagnosis
