White Matter Diseases with Radiologic-Pathologic Correlation.

Area of Science:

• Neurology
• Radiology
• Pathology

Background:

• White matter diseases involve impaired myelination, either through destruction (demyelinating) or formation (dysmyelinating) abnormalities.
• The pathogenesis of many white matter diseases is not fully understood.
• This review focuses specifically on demyelinating disorders.

Purpose of the Study:

• To review and categorize demyelinating white matter diseases.
• To correlate pathologic substrates with radiologic manifestations.
• To emphasize a systematic approach for differential diagnosis.

Main Methods:

• Categorization of demyelinating disorders into four main groups: autoimmune, infectious, vascular, and toxic-metabolic.
• Listing of specific conditions within each category.
• Discussion of the spectrum of imaging findings.

Main Results:

• Demyelinating disorders encompass autoimmune (e.g., multiple sclerosis), infectious (e.g., HIV encephalopathy), vascular (e.g., CADASIL), and toxic-metabolic (e.g., osmotic myelinolysis) processes.
• Imaging findings range from small multifocal lesions to extensive white matter involvement.
• Pathologic understanding is fundamental for interpreting radiologic findings.

Conclusions:

• A systematic radiologic approach, correlated with clinical and laboratory data, is crucial for diagnosing demyelinating white matter diseases.
• Recognizing the diverse etiologies and imaging patterns aids in differential diagnosis.
• Further understanding of pathogenesis is needed for many white matter disorders.