Scarpelli M, Salvolini U, Diamanti L, Montironi R, Chiaromoni L, Maricotti M
Institute of Pathological Anatomy and Histopathology, University of Ancona, Italy.
Neuroradiology. 1994 Jul;36(5):393-8. doi: 10.1007/BF00612126.
We examined 21 brains from individuals more than 65 years of age by MRI and neuropathological methods to study the frequency and morphology of white matter changes. There were 16 brains from neurologically normal subjects (Group 1) while the remaining 5 (Group 2) had neurological disturbances. In Group 1 MRI showed high signal areas in the periventricular white matter in 12 brains and in the deep white matter in 9. All had focal areas, with confluent zones in 4; 3 cystic infarcts were also detected. Neuropathology in this Group showed periventricular changes of variable extent in all cases, vacuolated myelin around the perivascular spaces in 14 and degenerate myelin in 4. Macroscopic inspection showed 3 cystic lacunar infarcts, while areas of recent infarction were present on histology in 2. Four of the Group 2 brains had periventricular MRI changes; high signal areas in deep white matter were focal in 2 and confluent in 1. Cystic infarcts were detected in 3 cases. Neuropathology showed periventricular changes in all the brains; in 4 myelin around the perivascular spaces was vacuolated while degenerate myelin was demonstrated in 1. There were also old (1) and recent (2) lacunar infarcts. High signal areas in the white matter thus have different histological backgrounds but only in a minority of cases do they seem to be of pathological significance and, as a rule, they are not related to the presence of neurological disturbances. Correlative MRI-neuropathological studies are helpful for characterising abnormalities detected by techniques, like MRI, which are sensitive but not very specific.
我们通过磁共振成像（MRI）和神经病理学方法检查了21例65岁以上个体的大脑，以研究白质变化的频率和形态。其中16例来自神经功能正常的受试者（第1组），其余5例（第2组）有神经功能障碍。在第1组中，MRI显示12例大脑的脑室周围白质有高信号区，9例大脑的深部白质有高信号区。所有病例均有局灶性区域，4例有融合区；还检测到3例囊性梗死。该组神经病理学检查显示，所有病例均有不同程度的脑室周围改变，14例血管周围间隙周围有泡状髓鞘，4例有髓鞘变性。肉眼检查显示3例囊性腔隙性梗死，组织学检查显示2例有近期梗死区域。第2组中有4例大脑有脑室周围MRI改变；深部白质的高信号区2例为局灶性，1例为融合性。3例检测到囊性梗死。神经病理学检查显示所有大脑均有脑室周围改变；4例血管周围间隙周围的髓鞘呈泡状，1例有髓鞘变性。还有陈旧性（1例）和近期（2例）腔隙性梗死。因此，白质中的高信号区有不同的组织学背景，但只有少数病例似乎具有病理学意义，而且通常与神经功能障碍的存在无关。MRI与神经病理学的相关性研究有助于对MRI等敏感但特异性不强的技术检测到的异常进行特征描述。
