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: 

• 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

• Weidauer S, Wagner M, Hattingen E. White Matter Lesions in Adults – a Differential Diagnostic Approach. Fortschr Röntgenstr 2020; 192: 1154 – 1173

Key words

white matter lesion - MRI - differential diagnosis

Publication History

Received: 14 April 2020

Accepted: 17 June 2020

Article published online:
20 July 2020

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