Zytotoxische Läsionen des Corpus callosum mit eingeschränkter Diffusion

Zytotoxische Balkenläsionen haben viele Ursachen. Sie müssen als das angesehen werden, was sie sind – als sekundäre Läsionen. Es ist daher wichtig, dass Ärzte mit den bekannten Ursachen zytotoxischer Balkenläsionen vertraut sind, damit diese ermittelt und angegangen werden können und nicht fälschlicherweise eine Ischämie diagnostiziert wird. Deshalb schildert dieser Artikel Mechanismen, Ursachen und Manifestationen zytotoxischer Balkenläsionen.

Abstract

Cytotoxic lesions of the corpus callosum (CLOCCs) are secondary lesions associated with various entities. CLOCCs have been found in association with drug therapy, malignancy, infection, subarachnoid hemorrhage, metabolic disorders, trauma, and other entities. In all of these conditions, cell-cytokine interactions lead to markedly increased levels of cytokines and extracellular glutamate. Ultimately, this cascade can lead to dysfunction of the callosal neurons and microglia. Cytotoxic edema develops as water becomes trapped in these cells. On diffusion-weighted magnetic resonance (MR) images, CLOCCs manifest as areas of low diffusion. CLOCCs lack enhancement on contrast material-enhanced images, tend to be midline, and are relatively symmetric. The involvement of the corpus callosum typically shows one of three patterns: (a) a small round or oval lesion located in the center of the splenium, (b) a lesion centered in the splenium but extending through the callosal fibers laterally into the adjacent white matter, or (c) a lesion centered posteriorly but extending into the anterior corpus callosum. CLOCCs are frequently but not invariably reversible. Their pathologic mechanisms are discussed, the typical MR imaging findings are described, and typical cases of CLOCCs are presented. Although CLOCCs are nonspecific with regard to the underlying cause, additional imaging findings and the clinical findings can aid in making a specific diagnosis. Radiologists should be familiar with the imaging appearance of CLOCCs to avoid a misdiagnosis of ischemia. When CLOCCs are found, the underlying cause of the lesion should be sought and addressed.

Kernaussagen

• CLOCC sind mit vielen Ursachen assoziiert. Sie müssen daher als das angesehen werden, was sie sind – als sekundäre Läsionen. So wurden CLOCC mit medikamentösen Therapien, malignen Erkrankungen, Infektionen, Subarachnoidalblutungen, metabolischen Störungen, Traumata und anderen Entitäten in Verbindung gebracht.

• Die Zytokinopathie an sich führt zu drastisch erhöhten Spiegeln von Glutamat im extrazellulären Raum. Dabei können die Spiegel gegenüber dem Normwert um das 100-Fache oder mehr erhöht sein.

• Die Folgen sind letztlich eine Funktionsstörung der Neuronen und Mikroglia im Corpus callosum und die Ausbildung eines zytotoxischen Ödems. Generell herrscht Einigkeit darüber, dass die Balkenläsionen mit Diffusionseinschränkung durch ein zytotoxisches Ödem verursacht werden.

• Radiologen sollten mit den Bildgebungsbefunden von CLOCC vertraut sein, um nicht fälschlicherweise eine Ischämie zu diagnostizieren: CLOCC stellen sich auf DWI-Bildern als Areale mit geringer Diffusion dar und zeigen in kontrastverstärkten Aufnahmen keine Kontrastmittelanreicherung. Sie sind tendenziell an der Mittellinie lokalisiert und relativ symmetrisch. Sie sind häufig, aber nicht ausnahmslos reversibel.

• Die Beteiligung des Balkens folgt typischerweise einem von 3 Mustern: Es zeigt sich eine kleine runde oder ovale Läsion im Zentrum des Spleniums, eine im Splenium lokalisierte Läsion, die sich über die Balkenstrahlung lateral in das umliegende Marklager ausbreitet, oder eine vom posterioren Abschnitt des Balkens ausgehende Läsion mit Expansion nach anterior.

Schlüsselwörter

zytotoxische Balkenläsionen - Entstehungsmechanismus - bildgebendes Muster - Ursachen

Keywords

cytotoxic lesions of the corpus callosum - molecular basics - MR imaging findings - causes

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