Imaging of White Matter Lesions

P re f a c e Imaging of White Matter Lesions

Sangam Kanekar, MD

Virtually all categories of pathologic conditions may cause white matter abnormalities. For the last four decades magnetic resonance (MR) imaging has established its role in the evaluation of white matter. The sensitivity of MR in identifying white matter is excellent. However, negotiating the exact cause of either the focal or the diffuse white matter remains challenging for the radiologist even on MR and is more so because many of the diseases appear similar, or one disease may have multiple white matter patterns on MR. For the last decade and a half, the evaluation of white matter has been further refined by advanced MR imaging techniques such as MR spectroscopy, diffusion tensor imaging (DTI), thin high-resolution sections, and MR perfusion imaging. These imaging modalities have significantly improved our ability to understand the basic etiopathogenesis of white matter disorders. Clinical evaluation and diagnosis of central nervous system disorders have always been challenging for clinicians. Imaging modalities play a vital role in diagnosing and directing the clinicians for appropriate clinical testing. The focus of this issue of Radiology Clinics of North America is to present a comprehensive review on “Imaging of White Matter.” This issue has a total of 11 articles and is balanced with conventional and high-end modalities in diagnosis and characterization of white matter diseases. The first article describes the for-

mation of the white matter, myelination, and corresponding changes on MR imaging. The next two articles give a very practical imaging approach on how to negotiate the focal and diffuse white matter lesions. The article on leukodystrophy is a very comprehensive approach to pediatric white matter diseases. White matter lesions, due to either multiple sclerosis or secondary demyelination disorders, are commonly encountered in the day-today practice. The fifth and sixth articles describe in detail the conventional and newer imaging techniques in regards to various demyelination disorders. Both articles also discuss and describe the various variants and differential diagnosis with diagnostic pearls to the specific diagnosis. Because viral infections often involve the white matter, clinical and imaging features of various viral infections are discussed in detail in the article on viral infection and white matter lesions. Dementia, due to various reversible and irreversible conditions, is thought to be the next big epidemic of the 21st century. Understanding the various reversible and preventable causes is important so that the appropriate intervention can be performed. Vascular dementia alone, or in combination with other neurodegenerative disorders like Alzheimer disease, is thought to be one of the leading causes of preventable dementia. The article on vascular dementia describes in detail the causes, pathogenesis, and various imaging findings. The next two articles are

Radiol Clin N Am 52 (2014) xi–xii http://dx.doi.org/10.1016/j.rcl.2013.12.005 0033-8389/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.

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Editor

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Preface dedicated to the application of the advanced imaging techniques: MR spectroscopy and DTI in various white matter lesions. These articles also describe the basics of these techniques and relevant physics. Like negotiating white matter of the brain, negotiating the hyperintensity in the spinal cord is also challenging. The last article describes the algorithmic approach to the spinal cord hyperintensity in both acute and chronic onset of myelopathy. I thank all the authors for their excellent contributions that make this issue an outstanding and comprehensive review on “Imaging of White Matter.” I would like to thank Dr Frank Miller for giving me an opportunity to be the guest editor on this issue and bringing this topic to a wider

audience. Finally, I thank my wife, Revati, and my children, Samika and Rachita, for their support and love. I hope you will enjoy reading this issue. Sangam Kanekar, MD Section of Neuroradiology Departments of Radiology, Neurology and Otolaryngology The Pennsylvania State University Milton S. Hershey Medical Center and College of Medicine 500 University Drive Hershey, PA 17033, USA E-mail address: [email protected]

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