The spectrum of subcortical lesions in MRI, sensitivity and specificity

Summary

Subcortical foci of increased signal intensity are frequently identified on MRI in the elderly. The lesions are compatible with various pathologic processes and MRI can only provide supportive data for a suspected diagnosis. Without the patient’s clinical history the radiologist is not able to differentiate between real pathologic lesions and physiologic aging processes. The high sensitivity of MRI in detecting white matter lesions and the lack of specificity recommands an excellent teamwork between clinicians and radiologists.

Magnetic resonance imaging increasingly used as a diagnostic modality, is highly sensitive to subtle changes of the subcortical brain parenchyma accompany a wide variety of neurologic disorders. While some of these white matter lesions occur in conjunction with known or suspected neurologic disease, others are unexpected or incidental. The question remains whether these latter changes represent early forms of occult neurologic disease or normal physiologic processes. To avoid pathologic or etiologic presumptions, Hachinski et al. (1987) suggested the term leuko-araiosis (LA) to denote areas of decreased attenuation on CT or increased intensity on T2 — weighted MR images.

The goal of this paper is to briefly review the literature regarding the sensitivity and specificity of white matter hyperintensities in T2 — weighted MR images, and to illustrate the problems of interpretation of these lesions in elderly patients.

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