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Apparent diffusion coefficient restriction in the white matter: going beyond acute brain territorial ischemia
Valentina Citton1, Alberto Burlina, Claudio Baracchini
1University of Padua, Neuroradiological Unit, Padova, Italy, valentina.citton@sanita.padova.it.
Background:
Reduction of apparent diffusion coefficient (ADC) values in white matter is not always ischaemic in nature.
Methods:
We retrospectively analysed our MRI records featuring reduced ADC values in the centrum semiovale without grey matter involvement or significant vasogenic oedema.
Results:
Several conditions showed the aforementioned MR findings: moose-horn lesions on coronal images in X-linked Charcot-Marie-Tooth disease; small fronto-parietal lesions in Menkes disease; marked signal abnormalities in the myelinised regions in the acute neonatal form of maple syrup urine disease; strip-like involvement of the corpus callosum in glutaric aciduria type 1; persistent periventricular parieto-occipital abnormalities in phenylketonuria; diffuse signal abnormalities with necrotic evolution in global cerebral anoxia or after heroin vapour inhalation; almost completely reversible symmetric fronto-parietal lesions in methotrexate neurotoxicity; chain-like lesions in watershed ischaemia; splenium involvement that normalises in reversible splenial lesions or leads to gliosis in diffuse axonal injury.
Conclusion:
Neuroradiologists must be familiar with these features, thereby preventing misdiagnosis and inappropriate management.
Insights
Reduced apparent diffusion coefficient (ADC) values in white matter can indicate various conditions beyond ischemia. Recognizing these diverse MRI findings is crucial for accurate diagnosis and appropriate patient management.
Area of Science:
- Neuroradiology
- Neuroimaging
- White Matter Diseases
Background:
- Reduced apparent diffusion coefficient (ADC) values in white matter are not exclusively indicative of ischemic events.
- This phenomenon can be associated with a spectrum of non-ischemic neurological conditions.
Purpose of the Study:
- To identify and characterize diverse neuroradiological findings associated with reduced white matter ADC values.
- To differentiate these findings from ischemic white matter injury.
Main Methods:
- Retrospective analysis of MRI records.
- Focus on centrum semiovale white matter with reduced ADC values, excluding grey matter involvement and significant vasogenic edema.
Main Results:
- Identified specific MRI patterns for various conditions: X-linked Charcot-Marie-Tooth disease (moose-horn lesions), Menkes disease (fronto-parietal lesions), maple syrup urine disease (neonatal form), glutaric aciduria type 1 (corpus callosum involvement), phenylketonuria (periventricular parieto-occipital abnormalities).
- Other findings included global cerebral anoxia/heroin inhalation (diffuse abnormalities with necrosis), methotrexate neurotoxicity (reversible fronto-parietal lesions), watershed ischemia (chain-like lesions), reversible splenial lesions, and diffuse axonal injury (splenium involvement).
Conclusions:
- Familiarity with these varied MRI features is essential for neuroradiologists.
- Accurate interpretation prevents misdiagnosis and ensures appropriate clinical management of non-ischemic white matter abnormalities.
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