Läsionen der weißen Substanz im Erwachsenenalter – ein differenzialdiagnostischer Ansatz

Zusammenfassung

Ziel Zerebrale Marklagerläsionen im MRT beim Erwachsenen sind eine häufige Befundkonstellation. Sie können einerseits einem klinisch inapparenten Zufallsbefund entsprechen, physiologisch oder altersassoziiert sein, oder andererseits die Ouvertüre einer schweren neurologischen Erkrankung darstellen. Mit Bezug auf pathophysiologische Aspekte werden praktische Hinweise für die differenzialdiagnostische Läsionsinterpretation im klinischen Alltag aufgezeigt.

Material und Methode Unter besonderer Berücksichtigung der vaskulären Architektur und Versorgung des zerebralen Marklagers werden physiologische Strukturen schematisch dargestellt und pathophysiologische Vorgänge mittels vergleichender Bildanalyse von möglichst identisch angulierten MR-Sequenzen hervorgehoben.

Ergebnisse Anhand charakteristischer bildmorphologischer und klinisch-neurologischer Befundkonstellationen sind die wichtigsten und häufigsten vaskulären, entzündlichen, metabolischen und neoplastischen Krankheitsentitäten dargestellt und die für die differenzialdiagnostische Zuordnung essenziellen Details hinsichtlich Signalverhalten und Lokalisation hervorgehoben.

Schlussfolgerung Mittels vergleichender Bildanalyse und dem Erkennen charakteristischer Läsionsmuster unter Berücksichtigung anatomischer Grundlagen und pathophysiologischer Vorgänge kann die differenzialdiagnostische Zuordnung von Marklagererkrankungen wesentlich gebahnt werden. Essenziell ist der Einbezug klinischer und laborchemischer Befunde.

Kernaussagen: 

• Marklagerläsionen können ein harmloser Nebenbefund oder eine Ouvertüre einer schweren neurologischen Erkrankung sein.

• Die vergleichende Bildanalyse von verschiedenen Sequenzen mit identischer Angulation ist entscheidend.

• Unter besonderer Berücksichtigung der vaskulären Anatomie lassen sich verschiedene Läsionsmuster erkennen.

• Der Einbezug neurologischer und laborchemischer Befundkonstellationen ist essenziell für die Differenzialdiagnose.

Zitierweise

• 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

Publikationsverlauf

Eingereicht: 14. April 2020

Angenommen: 17. Juni 2020

Artikel online veröffentlicht:
20. Juli 2020

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