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Neuroradiologie Scan 2013; 03(02): 107-126
DOI: 10.1055/s-0032-1325854
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© Georg Thieme Verlag KG Stuttgart · New York

Intrakranielle Läsionen hoher Signalintensität in T1-gewichteten MRT-Aufnahmen: Differenzialdiagnose[1]

Intracranial lesions with high signal intensity on T1-weighted MR images: differential diagnosis
Daniel T. Ginat
,
Steven P. Meyers
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Publication History

Publication Date:
22 April 2013 (online)

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Zusammenfassung

Verschiedene Substanzen, wie Methämoglobin, Melanin, Lipide, Proteine, Kalzium, Eisen, Kupfer und Mangan sind für die intrinsische hohe Signalintensität verantwortlich, die intrakranielle Läsionen in der T1-gewichteten Magnetresonanztomografie zeigen. Viele dieser Stoffe haben physikalische Eigenschaften, die zu weiteren spezifischen Merkmalen in der Bildgebung führen. So erzeugen lipidhaltige Läsionen häufig ein Chemical-Shift-Artefakt, und manche melaninhaltigen Läsionen zeigen gleichzeitig eine hohe Signalintensität in T1-gewichteten Aufnahmen und eine geringe Signalintensität in T2-gewichteten Aufnahmen. Lage und Ausdehnung einer Region anomaler Signalhyperintensität können hilfreiche Hinweise zur Identifizierung seltener Erkrankungen liefern. Beispiele dafür sind ein ektopischer Hypophysenhinterlappen in der Nähe des Bodens des III. Ventrikels, die bilaterale Beteiligung des Nucleus dentatus cerebelli und des Nucleus lenticularis beim Cockayne-Syndrom sowie die Beteiligung des anterioren Schläfenlappens und des Zerebellums bei der neurokutanen Melanose. In Fällen, in denen diagnostisch spezifische Merkmale in der T1-gewichteten Bildgebung fehlen, können Befunde aus anderen Pulssequenzen der Magnetresonanztomografie und anderen Modalitäten die Differenzialdiagnose einengen: Ein erhöhter Glutamin- oder Glutamatspiegel in der Magnetresonanzspektroskopie spricht für eine Leberenzephalopathie, ein popkornähnliches Erscheinungsbild in der T2-gewichteten Bildgebung für ein Kavernom und eine hyperdense Erscheinung in der Computertomografie für eine krankheitsbedingte Mineralablagerung. In vielen Fällen ermöglicht der Vergleich der Merkmale in der Bildgebung mit klinischen Parametern eine spezifische Diagnose.

Abstract

Various substances, including methemoglobin, melanin, lipid, protein, calcium, iron, copper, and manganese, are responsible for the intrinsically high signal intensity observed in intracranial lesions at T1-weighted magnetic resonance imaging. Many of these substances have physical properties that lead to other specific imaging features as well. For example, lipid-containing lesions frequently produce chemical shift artifact, and some melanin-containing lesions exhibit a combination of high signal intensity on T1-weighted images and low signal intensity on T2-weighted images. The location and extent of a region of abnormal signal hyperintensity may be helpful for identifying rare diseases such as an ectopic posterior pituitary gland near the floor of the third ventricle, bilateral involvement of the dentate and lentiform nuclei in Cockayne syndrome, and involvement of the anterior temporal lobe and cerebellum in neurocutaneous melanosis. In cases in which diagnostically specific T1-weighted imaging features are lacking, findings obtained with other magnetic resonance pulse sequences and other modalities can help narrow the differential diagnosis: An elevated glutamine or glutamate level at magnetic resonance spectroscopy is suggestive of hepatic encephalopathy; a popcorn ball-like appearance at T2-weighted imaging, of cavernous malformations; and hyperattenuation at computed tomography, of mineral deposition disease. In many cases, a comparison of imaging features with clinical measures enables a specific diagnosis.

1 © 2012 The Radiological Society of North America. All rights reserved. Originally published in English in RadioGraphics 2012; 32: 499 – 516. Online published in 10.1148/rg.321105761. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.


 

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