Lesões hiperintensas do pedúnculo cerebelar médio e além: ensaio iconográfico

Tamanini, João Vitor Gerdulli; Ribeiro, Guilherme Antonio Silva; Kimura, Adriana Tami; Borella, Luiz Fernando; Freddi, Tomás de Andrade; Reis, Fabiano

doi:10.1590/0100-3984.2024.0001

Table of contents previous current next

Table of contents

Pictorial Essay • Radiol Bras 57 • 2024 • https://doi.org/10.1590/0100-3984.2024.0001 linkcopiar

Lesões hiperintensas do pedúnculo cerebelar médio e além: ensaio iconográfico

Autoria SCIMAGO INSTITUTIONS RANKINGS

O pedúnculo cerebelar médio (PCM) é o maior sistema aferente do cerebelo e consiste de fibras do trato corticopontocerebelar. Especificamente, diversas doenças relevantes podem se apresentar com hipersinal em T2/FLAIR no PCM. Dentre elas, é possível citar esclerose múltipla, encefalomielite aguda disseminada, doenças do espectro da neuromielite óptica, leucoencefalopatia multifocal progressiva, encefalopatia hepática, síndrome da desmielinização osmótica, atrofia de múltiplos sistemas, síndrome de tremor e ataxia associada ao X frágil, leucoencefalopatia megalencefálica com cistos subcorticais, ataxias espinocerebelares, infarto hemipontino com degeneração transaxonal e glioma difuso de linha média com mutação de histona H3K27M. O objetivo dessa revisão iconográfica é discutir os achados de imagem dos principais diagnósticos diferenciais de doenças que se apresentam com hipersinal em T2/FLAIR no PCM, um conhecimento de grande relevância para o radiologista.

Unitermos:
Pedúnculo cerebelar médio; Esclerose múltipla; Neuromielite óptica; Encefalomielite aguda disseminada; Mielinólise central da ponte

Group	Disease	Usual age at presentation (years)	Most commonly affected gender	Distinguishing characteristics in imaging
	MS	20-40	Female	T2/FLAIR hyperintense lesions oriented perpendicular to the lateral ventricles
	ADEM	5-8	Male	Bilateral, asymmetric, poorly marginated, multifocal lesions, presenting with T2 hyperintensity
Demyelinating diseases	NMOSD	Approximately 40	Female	Characteristically involving the optic chiasm and retrochiasmatic regions, with lesions typically found in aquaporin 4-rich areas such as the periependymal regions abutting the ventricles
	PML	Depends on the specific cause leading to immunosuppression; most commonly seen in patients with AIDS, with CD4 counts of 50-100 cells/pL; potentially related to immunosuppressive monoclonal antibody therapy		Discrete multifocal, asymmetric, periventricular and subcortical involvement, with no significant mass effect or contrast enhancement
Toxic metabolic diseases	HE	Depends on the aetiology of liver dysfunction and portal hypertension		T2/FLAIR symmetric hyperintensity in the insula, thalamus and posterior limb of the internal capsule; hyperintensity on T1WI in the globus pallidus and anterior midbrain
Toxic metabolic diseases	ODS	Depends on the aetiology of the osmotic stress affecting oligodendroglial cells		Restricted diffusion in the pons; hyperintense signal on T2/FLAIR in the central portion of the pons, sparing the periphery
Degenerative diseases	MSA	54-61	Male	Hot cross bun sign in the pons on T2; disproportionate atrophy in the olivary nuclei and MCP
	FXTAS	Approximately 60 for tremor and ataxia	Male	T2/FLAIR hyperintense lesions in the MCPs and in the splenium of the corpus callosum
Genetic diseases	MLC	5	Male	Subcortical cysts, permanence of the cavum septum pellucidum, symmetric signal alteration of white matter
	SCA3	5-70 (median, 40)	Male	Pontine and cerebellar atrophy; atrophy of the globus pallidus atrophy in some patients with long-standing disease
Vascular diseases	PI with Wallerian degeneration	Depends on the stroke aetiology		Paramedian pontine hyperintensity on T2WI
Neoplastic diseases	Diffuse midline H3K27M-mutated glioma	5-11	No difference	T2 hyperintense lesion in the pons, thalamus or spinal cord

location_on

Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
E-mail: radiologiabrasileira@cbr.org.br

rss_feed Stay informed of issues for this journal through your RSS reader