Wenger Katharina J, Koldijk Caroline E, Hattingen Elke, Porto Luciana, Kurre Wiebke
Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany.
Gynacology Department, Buerger Hospital, 60318 Frankfurt am Main, Germany.
Children (Basel). 2023 Jan 24;10(2):206. doi: 10.3390/children10020206.
(1) Background and Purpose: The aim of this study was to retrospectively characterize WMSAs in an unselected patient cohort at a large pediatric neuroimaging facility, in order to learn more about the spectrum of the underlying disorders encountered in everyday clinical practice. (2) Materials and Methods: Radiology reports of 5166 consecutive patients with standard brain MRI (2006-2018) were searched for predefined keywords describing WMSAs. A neuroradiology specialist enrolled patients with WMSAs following a structured approach. Imaging characteristics, etiology (autoimmune disorders, non-genetic hypoxic and ischemic insults, traumatic white matter injuries, no final diagnosis due to insufficient clinical information, "non-specific" WMSAs, infectious white matter damage, leukodystrophies, toxic white matter injuries, inborn errors of metabolism, and white matter damage caused by tumor infiltration/cancer-like disease), and age/gender distribution were evaluated. (3) Results: Overall, WMSAs were found in 3.4% of pediatric patients scanned at our and referring hospitals within the ten-year study period. The majority were found in the supratentorial region only (87%) and were non-enhancing (78% of CE-MRI). WMSAs caused by autoimmune disorders formed the largest group (23%), followed by "non-specific" WMSAs (18%), as well as non-genetic hypoxic and ischemic insults (17%). The majority were therefore acquired as opposed to inherited. Etiology-based classification of WMSAs was affected by age but not by gender. In 17% of the study population, a definite diagnosis could not be established due to insufficient clinical information (mostly external radiology consults). (4) Conclusions: An "integrated diagnosis" that combines baseline demographics, including patient age as an important factor, clinical characteristics, and additional diagnostic workup with imaging patterns can be made in the majority of cases.
(1) 背景与目的：本研究旨在对一家大型儿科神经影像机构中未经挑选的患者队列中的白质微结构异常（WMSAs）进行回顾性特征分析，以便更多地了解日常临床实践中所遇到的潜在疾病谱。(2) 材料与方法：在5166例连续接受标准脑部磁共振成像（2006 - 2018年）的患者的放射学报告中搜索描述WMSAs的预定义关键词。一位神经放射学专家按照结构化方法纳入患有WMSAs的患者。评估影像特征、病因（自身免疫性疾病、非遗传性缺氧和缺血性损伤、创伤性白质损伤、因临床信息不足未得出最终诊断、“非特异性”WMSAs、感染性白质损伤、脑白质营养不良、中毒性白质损伤、先天性代谢缺陷以及肿瘤浸润/类癌疾病导致的白质损伤）以及年龄/性别分布。(3) 结果：总体而言，在为期十年的研究期间，在我们医院及转诊医院接受扫描的儿科患者中，3.4%发现有WMSAs。大多数仅见于幕上区域（87%）且无强化表现（对比增强磁共振成像的78%）。由自身免疫性疾病导致的WMSAs构成最大组（23%），其次是“非特异性”WMSAs（18%）以及非遗传性缺氧和缺血性损伤（17%）。因此，大多数是后天获得而非遗传所致。基于病因的WMSAs分类受年龄影响，但不受性别影响。在17%的研究人群中，由于临床信息不足（大多为外部放射学会诊）无法确立明确诊断。(4) 结论：在大多数情况下，可以做出一种“综合诊断”，将包括患者年龄这一重要因素在内的基线人口统计学特征、临床特征以及带有影像模式的额外诊断检查相结合。
