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Leukoaraiosis: A reappraisal. II. MRI studies

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Abstract

Magnetic resonance imaging is more sensitive than computed tomography to brain white matter changes of undefined significance observed in elderly subjects termed leuko-araiosis. Cross-sectional clinical studies have shown that these changes are more frequent or are more extensive in patients with cerebrovascular disease or vascular risk factors. Pathological studies have revealed that a number of alterations may underlie focal white matter changes including complete and incomplete lacunar infarcts, état criblé, dilated perivascular (Virchow-Robin) spaces, demyelination, and gliosis. Diffuse white matter changes are more difficult to explain. These might result from confluence of focal changes, or from diffuse white matter ischemia (incomplete infarct). Alternatively, they may be related to alterations of the transependymal CSF flow. Longitudinal studies in asymptomatic subjects correlating the MRI picture with clinical, pathophysiological, and histopathological data are needed in order to establish the significance and prognostic value of the different processes underlying LA, and to plan therapeutic strategies to prevent or treat them.

Sommario

La Risonanza Magnetica è più sensibile della TC nei confronti delle alterazioni della sostanza bianca encefalica di incerto significato osservate in soggetti anziani denominate leucoaraiosi. Studi clinici trasversali hanno dimostrato che la presenza o l'estensione di queste alterazioni è maggiore in soggetti con malattia cerebrovascolare o fattori di rischio vascolari. Studi patologici hanno rivelato che alterazioni di diverso tipo possono essere sottese alle lesioni focali: infarti lacunari completi ed incompleti, stato cribroso, spaziperivascolari (di Virchow-Robin) dilatati, demielinizzazione e gliosi. Più difficoltosa è attualmente l'interpretazione del significato delle lesioni diffuse. Queste potrebbero corrispondere ad uno stadio evolutivo delle lesioni focali, oppure essere il risultato di una ischemia diffusa della sostanza bianca. In alternativa potrebbero essere correlate ad alterazioni del flusso liquorale trans-ependimale. Studi longitudinali in soggetti asintomatici con correlazione dei reperti della Risonanza Magnetica con dati clinici, fisiopatologici ed istopatologici, sono necessari per una migliore comprensione del significato e del valore prognostico delle alterazioni della sostanza bianca corrispondenti alla leuco-araiosi. È questo presupposto indispensabile per la definizione di strategie terapeutiche mirate a prevenire o curare tali alterazioni.

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Authors and Affiliations

  1. Dipartimento di Fisiopatologia Clinica, Università di Firenze, Firenze, Italy

    Mascalchi M.

  2. Dipartimento di Scienze Neurologiche e Psichiatriche, Università di Firenze, Viale Morgagni 85, 50134, Firenze, Italia

    Inzitari D.

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Mascalchi, M., Inzitari, D. Leukoaraiosis: A reappraisal. II. MRI studies. Ital J Neuro Sci 12, 269–279 (1991). https://doi.org/10.1007/BF02337774

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