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Diffusion-weighted MR imaging in leukodystrophies.
[adrenomyeloneuropathy]
Leukodystrophies
are
genetically
determined
metabolic
diseases
,
in
which
the
underlying
biochemical
abnormality
interferes
with
the
normal
build-up
and
/
or
maintenance
of
myelin
,
which
leads
to
hypo-
(
or
arrested
)
myelination
,
or
dysmyelination
with
resultant
demyelination
.
Although
conventional
magnetic
resonance
imaging
has
significantly
contributed
to
recent
progress
in
the
diagnostic
work-up
of
these
diseases
,
diffusion-weighted
imaging
has
the
potential
to
further
improve
our
understanding
of
underlying
pathological
processes
and
their
dynamics
through
the
assessment
of
normal
and
abnormal
diffusion
properties
of
cerebral
white
matter
.
Evaluation
of
conventional
diffusion-weighted
and
ADC
map
images
allows
the
detection
of
major
diffusion
abnormalities
and
the
identification
of
various
edema
types
,
of
which
the
so
-called
myelin
edema
is
particularly
relevant
to
leukodystrophies
.
Depending
on
the
nature
of
histopathological
changes
,
stage
and
progression
gradient
of
diseases
,
various
diffusion-weighted
imaging
patterns
may
be
seen
in
leukodystrophies
.
Absent
or
low
-grade
myelin
edema
is
found
in
mucopolysaccharidoses
,
GM
gangliosidoses
,
Zellweger
disease
,
adrenomyeloneuropathy
,
L-
2
-
hydroxyglutaric
aciduria
,
non-
ketotic
hyperglycinemia
,
classical
phenylketonuria
,
Van
der
Knaap
disease
and
the
vanishing
white
matter
,
medium
grade
myelin
edema
in
metachromatic
leukodystrophy
,
X-
linked
adrenoleukodystrophy
and
HMG
coenzyme
lyase
deficiency
and
high
grade
edema
in
Krabbe
disease
,
Canavan
disease
,
hyperhomocystinemias
,
maple
syrup
urine
disease
and
leukodystrophy
with
brainstem
and
spinal
cord
involvement
and
high
lactate
.
Diseases
Validation
Diseases presenting
"medium grade myelin edema in metachromatic leukodystrophy"
symptom
adrenomyeloneuropathy
classical phenylketonuria
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