Hyperintense punctiform images in the white matter: A diagnostic approach

array:23 ["pii" => "S2173510712001000" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2011.09.001" "estado" => "S300" "fechaPublicacion" => "2012-07-01" "aid" => "506" "copyright" => "SERAM" "copyrightAnyo" => "2011" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Radiologia. 2012;54:321-35" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 27940 "formatos" => array:2 [ "HTML" => 24817 "PDF" => 3123 ] ] "itemSiguiente" => array:18 [ "pii" => "S2173510712000997" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2011.02.003" "estado" => "S300" "fechaPublicacion" => "2012-07-01" "aid" => "377" "copyright" => "SERAM" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Radiologia. 2012;54:336-41" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4336 "formatos" => array:2 [ "HTML" => 3356 "PDF" => 980 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Percutaneous Laser Disc Decompression for lumbar discogenic radicular pain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "336" "paginaFinal" => "341" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Descompresión percutánea discal con láser para el tratamiento del dolor lumbo-radicular de origen discal" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 990 "Ancho" => 992 "Tamanyo" => 96589 ] ] "descripcion" => array:1 [ "en" => "L4–L5 disc puncture under CT guidance, with the tip of the needle positioned at the center of the disc." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Duarte, J.C. Costa" "autores" => array:2 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Duarte" ] 1 => array:2 [ "nombre" => "J.C." "apellidos" => "Costa" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510712000997?idApp=UINPBA00004N" "url" => "/21735107/0000005400000004/v1_201305061502/S2173510712000997/v1_201305061502/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173510712001012" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2011.09.002" "estado" => "S300" "fechaPublicacion" => "2012-07-01" "aid" => "508" "copyright" => "SERAM" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Radiologia. 2012;54:306-20" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 5287 "formatos" => array:2 [ "HTML" => 4613 "PDF" => 674 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Update in Radiology" "titulo" => "Role of imaging techniques in the TNM classification of non-small cell bronchogenic carcinoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "306" "paginaFinal" => "320" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papel de las técnicas de imagen en la nueva clasificación TNM del carcinoma broncogénico no microcítico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 1136 "Ancho" => 1993 "Tamanyo" => 241894 ] ] "descripcion" => array:1 [ "en" => "Epidermoid carcinoma (not shown) in the right upper lobe in a 67-year-old patient. (a) Axial multidetector computed tomography (MDCT) image showed a nodular thickening of the right adrenal gland (solid arrow) with signal loss in the opposed-phase gradient-echo sequence (b), without hypersignal in the T2 sequence with fat suppression (c) and homogeneous enhancement after gadolinium administration. The characteristics of the lesion were consistent with an adenoma. Apart from this, the left adrenal gland was irregularly thickened (open arrow) on MDCT (e), without signal loss in opposed-phase imaging (f) but with hypersignal on T2 sequences (g), and showing peripheral and irregular enhancement. PET–CT and FNPA confirmed the diagnosis of metastasis (not shown)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Cano Alonso, L. Herráiz Hidalgo, E. Álvarez Moreno, C. Paniagua Correa, V. Martínez de Vega" "autores" => array:5 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Cano Alonso" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Herráiz Hidalgo" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Álvarez Moreno" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Paniagua Correa" ] 4 => array:2 [ "nombre" => "V." "apellidos" => "Martínez de Vega" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510712001012?idApp=UINPBA00004N" "url" => "/21735107/0000005400000004/v1_201305061502/S2173510712001012/v1_201305061502/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Update in Radiology" "titulo" => "Hyperintense punctiform images in the white matter: A diagnostic approach" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "321" "paginaFinal" => "335" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Medrano Martorell, M. Cuadrado Blázquez, D. García Figueredo, S. González Ortiz, J. Capellades Font" "autores" => array:5 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Medrano Martorell" "email" => array:1 [ 0 => "santimedra@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "¿" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Cuadrado Blázquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "D." "apellidos" => "García Figueredo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "S." "apellidos" => "González Ortiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Capellades Font" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital del Mar/IDIMAR-CRC Mar, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital de Granollers, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Imágenes puntiformes hiperintensas en la sustancia blanca: una aproximación diagnóstica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0075" "etiqueta" => "Figure 15" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr15.jpeg" "Alto" => 564 "Ancho" => 1800 "Tamanyo" => 151023 ] ] "descripcion" => array:1 [ "en" => "Vascular pattern: amyloid angiopathy. Significant changes of microvascular disease in the fronto-parieto-occipital supratentorial white matter with a vascular pattern (left). Gradient-echo sequences (centre) show punctate foci of hemosiderin in the cortico-subcortical interface, predominantly posterior (arrow), suggesting an underlying amyloid angiopathy. On the right, detail of the mural arteriolar deposits of congophilic β-amyloid matter." ] ] ] "textoCompleto" => "IntroductionThe interpretation of multiple hyperintense punctate images in the white matter in T2-weighted sequences, which are daily reported at magnetic resonance imaging (MRI) of adult brains, plays a major role in the routine practice of neuroradiologists.A parallelism can be established between the commonly used term unidentified bright objects (UBO)<a class="elsevierStyleCrossRef" href="#bib0005">1</a> and the term hyperintense punctate images in the white matter (HPIWM), which is presented in this paper. Accordingly, HPIWM is a semiological entity revealing at least five solitary hyperintense foci of up to 1cm in diameter on T2-weighted sequences, with or without confluent lesions with an overall diameter >1cm.The main goal of this paper is to simplify the radiologist's task when dealing with cases of HPIWM, so that radiologists can categorize the findings under a predominant pattern and make a more accurate diagnosis. This paper proposes three main HPIWM patterns based on the semiological characteristics: a vascular pattern (VP), which represents microvascular involvement (usually arteriolar); a perivascular pattern (PvP), which represents inflammatory disease (particularly demyelinating disease); and a non-specific pattern (NsP), which usually represents microvascular disease. To make a diagnosis, the predominant semiological pattern should be considered together with the clinical manifestations of patient and the epidemiologic data.Basic anatomy of brain microcirculationThe brain microcirculation consists of a vascular network with a very complex anatomy that varies across subjects. To understand the HPIWM patterns suggested, the basic aspects of brain microvascular anatomy will be addressed.Arterial microvascular systemThe cortical arteries cross the cerebral cortex and penetrate the white matter perpendicularly to the cortical surface, forming the terminal pial or medullary arterioles up to 4–5cm long. Along their course, they give off short cortical branches that supply the entire cerebral cortex and the fibres of the juxtacortical white matter (3–4mm), also called U-fibres. The cortical arteries establish multiple anastomoses, which provide the cerebral cortex with a rich arteriolar network. When running deep into the white matter, pial arteries establish very few capillary anastomoses with the neighbouring pial arterioles, forming relatively independent arteriolar metabolic units.The deep subependymal arteries, which arise from the choroid arteries, give off penetrating branches to the white matter, although with shorter course than that of the pial arteries.There is a second terminal system of cortical and subependymal arteries (lenticulostriated and thalamic perforating arteries) that supplies the basal ganglia (BG).The superficial and deep arteriolar systems (pial penetrating arteries and subependymal arteries) hardly anastomose with each other. For this reason, the parenchyma located on the bordering zone between the superficial and the deep vasculature is less vascularized. In contrast, the U-fibres are more and better vascularized than the rest of the white matter and BG<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Venous microvascular systemThe cerebral venules, also known as medullary venules, are divided into two large groups: superficial medullary venules, which are short venous channels draining to the cortical surface from about 1 or 2cm below the cerebral cortex; and the deep medullary venules, which are longer channels that drain perpendicularly to the ventricular surface towards the subependymal veins. There is a third group including transcerebral venules, less abundant and that connect both systems<a class="elsevierStyleCrossRefs" href="#bib0010">2,4</a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B).Perivascular spaceThe arterial system runs parallel to the venous system. The perivascular space surrounds the wall of arteries and arterioles (Virchow–Robin space) and veins and venules (perivenular space) from the subarachnoid space along their intraparenchymatous course. The superficial or cortical arterioles are surrounded by one layer of leptomeninges that separates the vascular surface from the periarteriolar space. The parenchymatous surface of this space is limited by the pia mater. The perivascular space of the penetrating arterioles of the BG is delimited by the two layers of leptomeninges that surround their endothelium. Apparently there is direct communication of the superficial and deep perivenular space with the subpial space, with no leptomeningeal layers separating them (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a><elsevierMultimedia ident="fig0010"></elsevierMultimedia>“Normal” hyperintense punctate images in the white matterThe presence of a few hyperintense punctate foci in the cerebral white matter at MRI is a very common finding that can be regarded as insignificant in most of the cases. These bright dots, considered as normal, can be a manifestation of dilated perivascular spaces or small gliotic or lacunar ischemic foci.At conventional MRI, perivascular spaces appear dilated (dPVS) in 13% of healthy adults and in only 3% of children between 20 months and 16 years of age.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> In a recent multicentre observational study, cerebral MRI studies using high-resolution 3D sequences of 1818 healthy individuals aged over 65 (dementia-free and with no history of cerebral infarction) were reviewed. dPVS were detected in all patients and dPVS larger than 3mm were detected in approximately one third of patients.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> dPVS appear as linear or fusiform foci with similar signal to that of the cerebrospinal fluid in all sequences (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Small perivascular spaces (<2mm) have been regarded as an anatomic variant,<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> whereas larger (>2mm) PVS have been associated with ageing,<a class="elsevierStyleCrossRef" href="#bib0030">6</a> dementia, early inflammatory stages in multiple sclerosis,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> and inflammatory reaction in traumatic brain injury.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> A number of recent studies have concluded that dPVS are associated with lacunar ischemic lesions, and thus, this finding can be considered as an indicator of cerebral small vessel disease.<a class="elsevierStyleCrossRefs" href="#bib0055">11–13</a> As an exception, perivascular spaces may be significantly dilated, typically in the mesencephalothalamic region. They can cause a significant mass effect and hydrocephalus and need to be distinguished from other tumefactive cystic lesions. These giant perivascular spaces are on many occasions incidentally discovered and their presence not always correlates with the clinical manifestations.<a class="elsevierStyleCrossRefs" href="#bib0045">9,14</a> Some studies have reported a poor association with different degrees of developmental delay, headaches, behaviour anomalies, and nonspecific epilepsy, as well as benign macrocephaly in the paediatric population<a class="elsevierStyleCrossRef" href="#bib0075">15</a> (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia>The appearance of ischemic-like lacunar foci in the periventricular and subcortical white matter is a physiological process because age is a cerebrovascular risk factor itself.<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a> Abnormalities of the white matter are almost ubiquitous (95%) in the population over the age of 65 years.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>There are different visual rating scales for age-related white matter changes (leukoaraiosis) showing a good correlation between them.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> One of the best known is the Fazekas scale,<a class="elsevierStyleCrossRef" href="#bib0100">20</a> which was integrated in the ARWMC scale (age-related white matter changes),<a class="elsevierStyleCrossRef" href="#bib0105">21</a> recommended when lesions of the white matter are not to be quantified by CT or MRI.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> This is a four-grade rating scale for punctate microvascular lesions in the white matter. Absence of lesions corresponds to grade 0; presence of non-confluent focal lesions corresponds to grade 1; initially confluent lesions correspond to grade 2; diffuse confluent lesions correspond to grade 3 (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). Based on this scale, a lesion is considered normal (attributed to ageing) and classified as grade 1, grade 2 is considered abnormal in patients <75 years, and grade 2 is considered abnormal in any age group.<a class="elsevierStyleCrossRef" href="#bib0115">23</a><elsevierMultimedia ident="fig0025"></elsevierMultimedia>There is a number of studies on pathologic and imaging correlation<a class="elsevierStyleCrossRefs" href="#bib0120">24–27</a> using magnetization transfer (MT) imaging studies that compare magnetization transfer ratios (MTR).<a class="elsevierStyleCrossRefs" href="#bib0140">28–30</a> These studies attempt to elucidate the nature of these lesions, and report differences between lesions in the perivascular white matter and subcortical lesions. Outcomes suggest that ageing induces anomalies in the ependymal membrane, which causes filtration of the cerebrospinal fluid. This filtration leads to gliosis and focal demyelinization of the parenchyma. In addition, subependymal penetrating microcirculation degenerates, which means that there is also a certain ischemic component associated, particularly in those cases in which periventricular leukoencephalopathy exhibits irregular borders. Apart from this, subcortical white matter lesions are essentially ischemic in nature due to the senile degeneration of the microcirculation.<a class="elsevierStyleCrossRefs" href="#bib0120">24–30</a>“Abnormal” hyperintense punctate images in the white matterWhen the HPIWM is pathological, it may be indicative of an acquired or inherited disease. Among the acquired diseases of the white matter, microvascular hypoxicoischemic disease is by far the most common, no matter whether atherothrombotic, embolic or caused by cerebrovascular risk factors (CVRFs). The acquired origin should be considered the first diagnostic option, even in the absence of typical CVRFs, unless there are clinical and analytic evidence suggestive of a different aetiology. Multiple sclerosis (MS) is the second most common disorder, with vasculitis, infection, intoxication, and trauma (among other causes) trailing far behind.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> A large number of patients with a very low vascular risk present with lesions of microvascular appearance for which there is relatively often no alternative or final diagnosis.With respect to inherited disorders, leukodystrophic diseases are a group of rare diseases. Although they usually occur in the paediatric age, they can present in adult age. They are metabolic diseases that usually affect the white matter in a quite symmetric and extensive (not punctate) manner, and usually damage the brainstem and the cerebellum. An exception is mitochondrial diseases, which cause more asymmetric lesions, and normally affect the grey matter. In adults, the most common are metachromatic leukodystrophy, globoid cell leukodystrophy, adrenomyeloneuropathy, mitochondrial disorders, vanishing white matter, and cerebrotendinous xanthomatosis.<a class="elsevierStyleCrossRef" href="#bib0155">31</a>Basic pathophysiologyOne possible mechanism of damage of the white matter is the primary involvement of an arteriole or cerebral venule, which compromises the blood supply of the parenchyma that depends on them, and induces a lesion. White matter microvascular disease encompasses a wide range of conditions: hypoxia-ischemia, granulomatous or nongranulomatous inflammation, infection, disease caused by substance deposit, toxins, metabolic disease, traumatism, etc. Another possible pathophysiological mechanism of leukoencephalopathy is cell infiltration or deposition of pathologic substances in the perivascular space that can also manifest radiologically as focal lesions in the white matter. They have a non-infectious inflammatory aetiology (as is the case of MS or other demyelinating diseases, some types of vasculitis, and some granulomatous diseases), an atypical infectious aetiology (Lyme's disease, cryptococcosis, parenchymatous cysticercosis), a metabolic aetiology (mucopolysaccharidosis) or a traumatic aetiology (diffuse axonal injury). Both pathophysiological mechanisms may co-occur in one same disease.White matter disease can be approached by taking into account the anatomy of cerebral microcirculation and its interstitium, specifically by determining the most affected elements in the different leukoencephalopathic groups. In this respect, our goal is to get insights into the pathophysiology of the disease underlying the HPIWM by identifying the predominant semiological pattern. Three main patterns can be defined on the basis of several semiological elements:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•A vascular pattern (VP) or microvascular pattern, which is usually caused by an arteriolar lesion, and is the most prevalent (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>A).<elsevierMultimedia ident="fig0030"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0010">•A perivascular pattern (PvP), which is usually caused by perivascular inflammation, among other less common causes. The paradigm of this pattern is MS, for which an autoimmune perivenular inflammation has been reported that causes demyelinization<a class="elsevierStyleCrossRef" href="#bib0160">32</a> (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>B).</li><li class="elsevierStyleListItem" id="lsti0015">•A non-specific pattern (NsP), when neither of the previous patterns can be identified, and which is normally caused by microvascular disease.</li></ul>Semiological elements in hyperintense punctate lesions in the white matterFor the radiologic approach of a case of HPIWM, the semiological elements to be analysed are distribution and location, shape, size, enhancement after contrast administration, presence of haemorrhage or microhaemorrhage, and grey matter involvement. Description of each of these elements may help identify one of the three semiological patterns suggested, thus facilitating an adequate differential diagnosis for each case.Distribution and locationHPIWM may present with a predominantly supratentorial, infratentorial or supra- and infratentorial distribution. As shall be shown below, the presence of lesions with an essentially supratentorial distribution generally suggests small vessel disease as a first option, which favours a VP (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>). This suggestion is further supported by a predominantly frontoparietal distribution.<elsevierMultimedia ident="fig0035"></elsevierMultimedia>Supratentorial distribution concerns four large areas: subcortical area, periventricular area, deep area, and corpus callosum (<a class="elsevierStyleCrossRef" href="#fig0040">Fig. 8</a>).<elsevierMultimedia ident="fig0040"></elsevierMultimedia>A subcortical lesion can be located either in direct contact with the cerebral cortex (juxtacortical) thus affecting subcortical U-fibres of the white matter, or can be located inside these fibres, which would not be affected. In this latter case, the lesion is classified as sub-U subcortical. A sub-U subcortical lesion suggests a VP,<a class="elsevierStyleCrossRef" href="#bib0165">33</a> whereas a juxtacortical lesion is more suggestive of a PvP, which is typically associated with MS (a PvP is present in one third of MS cases).<a class="elsevierStyleCrossRef" href="#bib0170">34</a>A lesion will be regarded as periventricular when it is in contact or virtually in contact (closer than 1cm)<a class="elsevierStyleCrossRef" href="#bib0175">35</a> with the ependymal surface. Both microvascular and perivascular lesions can have a periventricular location, the shape of the lesion being the key semiological element.The deep region is located between the subcortical and periventricular regions. The deep region is classified as bordering when located in a border zone between two vascular areas, which is indicative of a VP, or as non-bordering when not clearly located in a border zone, which is indicative of an NsP. The corpus callosum is a specific location as well, as in some other diseases, such as MS—typically in the callosal-septal interface,<a class="elsevierStyleCrossRef" href="#bib0170">34</a>—in the Susac syndrome<a class="elsevierStyleCrossRefs" href="#bib0170">34,36,37</a> or in the cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL),<a class="elsevierStyleCrossRef" href="#bib0190">38</a> among others.Infratentorial lesions can have a peripheral location, in contact with the surface of the parenchyma, or a central location, with no involvement of the surface. A central lesion is typically associated with a VP, whereas a peripheral lesion is typically associated with a PvP<a class="elsevierStyleCrossRef" href="#bib0170">34</a> (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>).MorphologyThere are several lesion types according to their shape: oval or fusiform, punctate or roundish, and amorphous (<a class="elsevierStyleCrossRef" href="#fig0045">Fig. 9</a>). Punctate, roundish, and amorphous lesions are non-specific, whereas oval or fusiform lesions usually have a distribution parallel to the cerebral microcirculation, and thus, they normally feature a PvP. Oval or fusiform periventricular lesions in a radial pattern and perpendicular to the longitudinal axis of the lateral ventricles are quite a common feature of MS. They are known as Dawson's fingers,<a class="elsevierStyleCrossRef" href="#bib0170">34</a> after the neuropathologist James Dawson, who described finger-like venular and perivenular inflammatory cells in MS patients.<a class="elsevierStyleCrossRef" href="#bib0195">39</a> Confluence of these lesions makes up a ridge-like configuration, which is also associated with MS.<a class="elsevierStyleCrossRef" href="#bib0170">34</a> CVRF-induced microvascular periventricular leukoencephalopathy presents with typically more irregular borders.<a class="elsevierStyleCrossRefs" href="#bib0015">3,40</a><elsevierMultimedia ident="fig0045"></elsevierMultimedia>SizeLocalization of an isolated lesion (not several confluent lesions) >10–15mm in size is suggestive of a PvP (lacunar infarctions are acknowledged to reach 15mm).<a class="elsevierStyleCrossRef" href="#bib0205">41</a> Smaller lesions are non-specific, and can be indicative either of a microvascular or a perivascular lesion (<a class="elsevierStyleCrossRef" href="#fig0050">Fig. 10</a>).<elsevierMultimedia ident="fig0050"></elsevierMultimedia>Enhancement after contrast administrationAlthough a non-specific finding, the absence of enhancement on leukoencephalopathic foci is suggestive of an inactive stage of the disease. In contrast, the active inflammatory stage of the disease usually involves an increase in permeability or absence of the blood–brain barrier and gadolinium enhancement of the lesion. Punctate, peripheral (in complete or incomplete ring) or central (homogeneous or heterogeneous) contrast enhancement can be observed. Enhancing patterns are generally a non-specific finding, except for peripheral incomplete ring-enhancement, which has been reported as a finding typically associated with MS,<a class="elsevierStyleCrossRefs" href="#bib0170">34,36</a> and thus, suggestive of a PvP (<a class="elsevierStyleCrossRef" href="#fig0055">Fig. 11</a>).<elsevierMultimedia ident="fig0055"></elsevierMultimedia>When an image is suspicious of MS, the current diagnostic criteria of the MAGNIMS (magnetic imaging in MS)<a class="elsevierStyleCrossRef" href="#bib0210">42</a> group do not require gadolinium enhancement as part of the diagnosis for dissemination in space. However, one enhancing lesion among non-enhancing lesions in the same MRI study is enough to determine dissemination in time.In the follow-up of the disease, many authors opt for contrast administration for the assessment of active inflammation and response to treatment. The number of enhancing lesions may also help predict the prognosis of the disease.<a class="elsevierStyleCrossRef" href="#bib0170">34</a>Haemorrhage or microhaemorrhageAt MRI, images of microbleeding are associated with HPIWM in at least 18% of the population over 60 years of age. HPIWM are present in over 95% of the population over 65 years of age. These data provide further evidence of the mixed microvascular disease, which shares a pathophysiological origin with white matter disease and microbleeding.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> When a VP with foci of microbleeding is observed in T2*, two pathologic entities are possible: arterial hypertension (AH) and amyloid angiopathy (AA). Involvement of the deep region of the BG and infratentorial involvement suggest hypertensive or arteriosclerotic microangiopathy, whereas a peripheral location in the cerebral cortex or lobes of the bleeding is typically associated with AA<a class="elsevierStyleCrossRef" href="#bib0215">43</a> (<a class="elsevierStyleCrossRef" href="#fig0060">Fig. 12</a>).<elsevierMultimedia ident="fig0060"></elsevierMultimedia>Patients with vasculitis present with foci of cerebral bleeding associated with white matter microvascular-like lesions and cortical ischemic lesions appearing at the onset or secondary to infarct transformation.<a class="elsevierStyleCrossRef" href="#bib0220">44</a>Another cause of HPIWM with residual bleeding is the diffuse axonal injury associated with a high-energy traumatic injury. Residual foci of leukoencephalopathy with traces of haemosiderin are detected at the grey matter-white matter border, mainly located in the frontal lobe and typically in the region of basal nuclei and in the splenium of the corpus callosum<a class="elsevierStyleCrossRef" href="#bib0225">45</a> (<a class="elsevierStyleCrossRef" href="#fig0060">Fig. 12</a>).Grey matter involvementMost HPIWM cases are associated with cortical lesions or lesions of the BG region.Co-presence of lesions in the cerebral cortex and multiple bright foci in the white matter is a non-specific finding. In patients with vasculitis-induced microvascular disease, it is not uncommon to detect peripheral lesions with cortical involvement, which usually represent areas of ischemic infarction.<a class="elsevierStyleCrossRef" href="#bib0220">44</a> However, they are not readily visualized in conventional MRI sequences.<a class="elsevierStyleCrossRef" href="#bib0170">34</a>GB involvement typically occurs in patients with hypertense or arteriosclerotic microangiopathy<a class="elsevierStyleCrossRef" href="#bib0200">40</a> (<a class="elsevierStyleCrossRef" href="#fig0065">Fig. 13</a>), and is very rare in MS patients.<a class="elsevierStyleCrossRef" href="#bib0170">34</a> In patients with acute disseminated encephalomielities (ADEM), who may present with lesions indistinguishable from those of MS, the BG region and the spinal cord are usually affected.<a class="elsevierStyleCrossRefs" href="#bib0180">36,46</a> Diverse forms of vasculitis (systemic lupus erythematosus [SLE], Behçet's disease, etc.) and neurosarcoidosis can affect the BG.<a class="elsevierStyleCrossRefs" href="#bib0220">44,47,48</a> Immunocompromised patients with cryptococcosis typically present with gelatinous cysts in the perivascular space of the lenticulostriated and thalamic perforating arterioles of the BG.<a class="elsevierStyleCrossRef" href="#bib0245">49</a><elsevierMultimedia ident="fig0065"></elsevierMultimedia>Differential diagnosisThe general features of each pattern can be defined by considering each of the semiological elements described (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). An adequate differential diagnosis can be made by identifying the predominant pattern and the specific aspects of each case.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Vascular patternA vascular pattern in microvascular hypoxic-ischemic disease secondary to CVRFs (especially AH, dyslipidemia, and diabetes) is associated with a great number of lesions that are normally identified in the majority of semiological findings described by this pattern. AH produces traces of haemosiderin, which can be observed in T2*-weighted sequences, particularly in the corpus striatum, thalami, cerebellum, and brainstem (<a class="elsevierStyleCrossRef" href="#fig0070">Fig. 14</a>).<elsevierMultimedia ident="fig0070"></elsevierMultimedia>As already mentioned, microvascular involvement in AA is associated with a VP, typically manifested as cortical foci of peripheral microhaemorrhage or areas of haemorrhage in cerebral lobes<a class="elsevierStyleCrossRefs" href="#bib0090">18,50,51</a> (<a class="elsevierStyleCrossRef" href="#fig0075">Fig. 15</a>).<elsevierMultimedia ident="fig0075"></elsevierMultimedia>Studies with migraine patients have reported microvascular-like HPIWM,<a class="elsevierStyleCrossRefs" href="#bib0260">52,53</a> predominantly frontal or located in the semioval centres<a class="elsevierStyleCrossRef" href="#bib0270">54</a> (<a class="elsevierStyleCrossRef" href="#fig0080">Fig. 16</a>). A recent study with 780 participants confirms this association both in patients with migraine headache and in patients presenting with other headache disorders, especially tension-related headaches. Prevalence for tension-related and migraine headaches was 34% and 32%, respectively, and both were much higher than prevalence for HPIWM in the controls (7.4%).<a class="elsevierStyleCrossRef" href="#bib0175">35</a> Migraine with aura has been shown to have a stronger association with clinical or subclinical ischemic infarcts, particularly in the posterior circulation territory (cerebellum, protuberance).<a class="elsevierStyleCrossRef" href="#bib0270">54</a> Additionally, and irrespective of the headache type, the presence of cerebral abnormalities does not seem to be associated with cognitive impairment.<a class="elsevierStyleCrossRef" href="#bib0175">35</a><elsevierMultimedia ident="fig0080"></elsevierMultimedia>Most blood vessels affected by vasculitis in the central nervous system present with HPIWM typical of a VP, with a certain subcortical prevalence and associated with cortical ischemic lesions and foci of intraparenchymatous bleeding appearing at the onset or secondary to infarct transformation.<a class="elsevierStyleCrossRef" href="#bib0220">44</a> Traces of peripheral microhaemorrhage can be found in the BG due to septic vasculitis<a class="elsevierStyleCrossRef" href="#bib0250">50</a> and vasculitis caused by vasoactive drugs, such as cocaine and alkaloid derivatives, amphetamine, ephedrine and phenylpropanolamine<a class="elsevierStyleCrossRefs" href="#bib0220">44,50</a> (<a class="elsevierStyleCrossRef" href="#fig0085">Fig. 17</a>).<elsevierMultimedia ident="fig0085"></elsevierMultimedia>CADASIL integrates all features typical of VP associated with bilateral temporal involvement of the anterior poles, the external capsules, and the corpus callosum in the callosal-septal interface<a class="elsevierStyleCrossRefs" href="#bib0275">55–57</a> (<a class="elsevierStyleCrossRef" href="#fig0090">Fig. 18</a>).<elsevierMultimedia ident="fig0090"></elsevierMultimedia>In short, a leukoencephalopathy can be caused by HPIWM with VP if the patient presents with CVRFs. Otherwise, the differential diagnosis focuses on other causes of microvascular abnormalities, such as AA, headache, toxic-metabolic diseases, some forms of vasculitis and CADASIL, among others.Perivascular patternHPIWM with a perivascular pattern is suggestive of MS as the first diagnostic option. The most characteristic semiological findings are: juxtacortical and periventricular ovoid lesions in the form of Dawson's fingers, typically in contact with the inferior aspect of the corpus callosum (callosal-septal lesions) or adjacent to the anterior aspect of the temporal horn; peripheral infratentorial lesions adjacent to the floor of the fourth ventricle, in the middle cerebellar peduncles and in the brainstem<a class="elsevierStyleCrossRef" href="#bib0170">34</a> (<a class="elsevierStyleCrossRef" href="#fig0095">Fig. 19</a>).<elsevierMultimedia ident="fig0095"></elsevierMultimedia>If other clinical or analytic indications favour MS, the patient is treated as having MS before the final diagnosis of dissemination in space and time, in consonance with the MAGNIMS criteria.<a class="elsevierStyleCrossRef" href="#bib0210">42</a> If the clinical setting is not suggestive of MS, the differential diagnosis will include other diseases with a likely autoimmune aetiology, such as atypical MS, ADEM, SLE, Sjögren's disease, and sarcoidosis,<a class="elsevierStyleCrossRefs" href="#bib0235">47,48</a> infections such as Lyme's disease<a class="elsevierStyleCrossRef" href="#bib0290">58</a> and cryptococcosis,<a class="elsevierStyleCrossRef" href="#bib0245">49</a> some forms of vasculitis, such as Behçet's disease,<a class="elsevierStyleCrossRef" href="#bib0295">59</a> and metabolic diseases, such as mucopolysaccharidosis.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>Non-specific patternLeukoencephalopathy can be caused by HPIWM with an NsP if the patient presents with CVRFs. Otherwise, the differential diagnosis firstly focuses on causes of atypical microvascular disease, and secondly, on uncommon causes of perivascular disease.The summary chart in <a class="elsevierStyleCrossRef" href="#fig0100">Fig. 20</a> suggests a diagnostic algorithm to be used in an HPIWM case. This algorithm may help make an adequate differential diagnosis once the predominant pattern has been identified.<elsevierMultimedia ident="fig0100"></elsevierMultimedia>ConclusionsThis study proposes a practical and simple diagnostic tool on the basis of three main semiological patterns of hyperintense punctate images in the white matter: a vascular pattern, a perivascular pattern, and a non-specific pattern. These patterns are established based on the anatomy of cerebral microcirculation. Identifying the predominant semiological pattern enables to narrow down the etiological diagnosis. Most bright dots visualized at MRI of the brain have a vascular aetiology. MS is the most common cause of PvP. An NsP is more likely to be an atypical manifestation of vascular aetiology.Authorship<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020">1.Responsible for the integrity of the study: SM.</li><li class="elsevierStyleListItem" id="lsti0025">2.Conception of the study: SM, MC and DG.</li><li class="elsevierStyleListItem" id="lsti0030">3.Design of the study: SM.</li><li class="elsevierStyleListItem" id="lsti0035">4.Acquisition of data: SM.</li><li class="elsevierStyleListItem" id="lsti0040">5.Analysis and interpretation of data: SM, MC, DG, JC and SG.</li><li class="elsevierStyleListItem" id="lsti0045">6.Statistical analysis: N/A.</li><li class="elsevierStyleListItem" id="lsti0050">7.Bibliographic search: SM, MC and DG.</li><li class="elsevierStyleListItem" id="lsti0055">8.Drafting of the manuscript: SM, MC and DG.</li><li class="elsevierStyleListItem" id="lsti0060">9.Critical review with intellectually relevant contributions: SM, MC, DG, JC and SG.</li><li class="elsevierStyleListItem" id="lsti0065">10.Approval of the final version: SM, MC, DG, JC and SG.</li></ul>Conflicts of interestsThe author declares no conflicts of interests." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:2 [ "identificador" => "xres122028" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec109315" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres122029" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec109316" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Basic anatomy of brain microcirculation" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Arterial microvascular system" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Venous microvascular system" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Perivascular space" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "“Normal” hyperintense punctate images in the white matter" ] 7 => array:3 [ "identificador" => "sec0035" "titulo" => "“Abnormal” hyperintense punctate images in the white matter" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Basic pathophysiology" ] 1 => array:3 [ "identificador" => "sec0045" "titulo" => "Semiological elements in hyperintense punctate lesions in the white matter" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Distribution and location" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Morphology" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Size" ] 3 => array:2 [ "identificador" => "sec0065" "titulo" => "Enhancement after contrast administration" ] 4 => array:2 [ "identificador" => "sec0070" "titulo" => "Haemorrhage or microhaemorrhage" ] 5 => array:2 [ "identificador" => "sec0075" "titulo" => "Grey matter involvement" ] ] ] 2 => array:3 [ "identificador" => "sec0080" "titulo" => "Differential diagnosis" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0085" "titulo" => "Vascular pattern" ] 1 => array:2 [ "identificador" => "sec0090" "titulo" => "Perivascular pattern" ] 2 => array:2 [ "identificador" => "sec0095" "titulo" => "Non-specific pattern" ] ] ] ] ] 8 => array:2 [ "identificador" => "sec0100" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0105" "titulo" => "Authorship" ] 10 => array:2 [ "identificador" => "sec0110" "titulo" => "Conflicts of interests" ] 11 => array:2 [ "identificador" => "xack37812" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-01-30" "fechaAceptado" => "2011-09-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec109315" "palabras" => array:6 [ 0 => "White matter" 1 => "Magnetic resonance" 2 => "Leukoaraiosis" 3 => "Multiple sclerosis" 4 => "CADASIL" 5 => "Vasculitis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec109316" "palabras" => array:6 [ 0 => "Sustancia blanca" 1 => "Resonancia magnética" 2 => "Leucoaraiosis" 3 => "Esclerosis múltiple" 4 => "CADASIL" 5 => "Vasculitis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The presence of hyperintense punctiform images in the white matter in T2-weighted magnetic resonance (MR) sequences is a very common finding and is occasionally a diagnostic challenge for the radiologist.The present article attempts, using an anatomical approach to the brain circulation, as well as from histopathology correlation studies, to simplify the task of interpreting these images from the description of the three main patterns of hyperintense punctiform images in the white matter: vascular pattern, which corresponds to microvascular lesions; perivascular pattern, which represents inflammatory disease of which the paradigm is multiple sclerosis; and a non-specific pattern, which has to be a microvascular disease.From the various semiological elements in the MR images, a predominant pattern can be determined in each case and, in this way, helps in the differential diagnosis." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "La presencia de múltiples imágenes puntiformes hiperintensas en la sustancia blanca (IPHSB) en las secuencias de resonancia magnética (RM) ponderadas en T2 es un hallazgo muy frecuente y, en ocasiones, un reto diagnóstico para el radiólogo.Este artículo pretende, a través de una aproximación a la anatomía de la microcirculación cerebral, así como a estudios de correlación anatomopatológica, simplificar la tarea de interpretación de estas imágenes a partir de la descripción de tres principales patrones de presentación de IPHSB: patrón vascular (PV), que corresponde a lesiones microvasculares, patrón perivascular (PpV), que representa a la enfermedad inflamatoria cuyo paradigma es la esclerosis múltiple (EM), y patrón inespecífico (PI), que suele deberse a enfermedad microvascular.A partir de varios elementos semiológicos en las imágenes de RM se puede determinar un patrón predominante en cada caso y, de este modo, acotar el diagnóstico diferencial." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Medrano Martorell S, et al. Imágenes puntiformes hiperintensas en la sustancia blanca: una aproximación diagnóstica. Radiología. 2012;54:321–35." ] ] "multimedia" => array:21 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1930 "Ancho" => 2500 "Tamanyo" => 425967 ] ] "descripcion" => array:1 [ "en" => "Cerebral microcirculation. (A) Arterial microcirculation. 1: cortical arteries; 2: pial arteries; 2.1: short branches; 3: subependymal arteries; 4: subependymal perforating arterioles; 5: lenticulostriated and thalamic perforating arterioles; 6: transcerebral arterioles. (B) Venous microcirculation. 1: cortical veins; 2: superficial medullary venules; 3: subependymal venules; 4: deep medullary venules." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1162 "Ancho" => 1728 "Tamanyo" => 352586 ] ] "descripcion" => array:1 [ "en" => "Perivascular space. (A) Periarteriolar space of the pial arterioles surrounded by one leptomeningeal layer that separates it from the subpial space (arrow). Periarteriolar space of lenticulostriated arterioles surrounded by two leptomeningeal layers that separate it from the subpial space (arrowheads in the upper box and asterisks in the lower box); (B) perivenular space that communicates with the subpial space (arrow); (C) photomicrographic detail of the perivascular Virchow–Robin space (arrows) (courtesy of Dr. Susana Boluda).<a class="elsevierStyleCrossRef" href="#bib0025">5</a>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1313 "Ancho" => 1400 "Tamanyo" => 183939 ] ] "descripcion" => array:1 [ "en" => "Perivascular spaces dilated in the corona radiata (A), the semioval centre (B), and the mesencephalic region (C). T1 (shown) and FLAIR sequences demonstrate similar signal to that of the cerebrospinal fluid (D)." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1224 "Ancho" => 950 "Tamanyo" => 118649 ] ] "descripcion" => array:1 [ "en" => "Five-year old child with headache. Visualization of dilated perivascular spaces is an incidental finding with a dubious or unlikely clinical relevance." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1157 "Ancho" => 2167 "Tamanyo" => 257661 ] ] "descripcion" => array:1 [ "en" => "ARWMC scale (age-related white matter changes) to assess punctate lesions in the white matter using computed tomography and magnetic resonance." ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 718 "Ancho" => 1500 "Tamanyo" => 216627 ] ] "descripcion" => array:1 [ "en" => "(A) Pathophysiology of the vascular pattern. The picture features the mural and/or endoluminal microvascular lesion that induces the ischemic lesion of the parenchyma. Note the mural hyalinization caused by hypertensive arteriopathy (arrow) and the adjacent ischemic vacuolation (*); (B) pathophysiology of the perivascular pattern. The picture features a perivascular pathological process and the adjacent parenchymatous lesion. Demyelinating layer caused by perivenular inflammation in a patient with multiple sclerosis." ] ] 6 => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 1365 "Ancho" => 2500 "Tamanyo" => 332187 ] ] "descripcion" => array:1 [ "en" => "Distribution. A mainly supratentorial distribution with frontoparietal prevalence is typical of the vascular pattern. The infratentorial involvement with peripheral distribution suggests a perivascular pattern. The infratentorial involvement with central distribution suggests a vascular pattern." ] ] 7 => array:7 [ "identificador" => "fig0040" "etiqueta" => "Figure 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 1737 "Ancho" => 2647 "Tamanyo" => 319499 ] ] "descripcion" => array:1 [ "en" => "Location: (1) juxtacortical; (2) sub-U subcortical; (3) non-bordering deep subcortical; (4) bordering subcortical; (5) periventricular, and (6) corpus callosum. A predominantly juxtacortical involvement or involvement of the corpus callosum is not indicative of a vascular pattern (VP); the rest of locations favour a VP or a non-specific pattern, and thus, suggest a microvascular cause. Periventricular lesions may be indicative of a VP or a perivascular pattern depending on the shape of the lesion." ] ] 8 => array:7 [ "identificador" => "fig0045" "etiqueta" => "Figure 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 1697 "Ancho" => 2502 "Tamanyo" => 248745 ] ] "descripcion" => array:1 [ "en" => "Morphology. Ovoid or fusiform lesions suggest a perivascular pattern; the rest are non-specific." ] ] 9 => array:7 [ "identificador" => "fig0050" "etiqueta" => "Figure 10" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr10.jpeg" "Alto" => 2321 "Ancho" => 1667 "Tamanyo" => 210190 ] ] "descripcion" => array:1 [ "en" => "Size. Lesions larger than 10–15mm (not several confluent lesions) suggest a perivascular pattern (inflammation, infection)." ] ] 10 => array:7 [ "identificador" => "fig0055" "etiqueta" => "Figure 11" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr11.jpeg" "Alto" => 1459 "Ancho" => 2083 "Tamanyo" => 223385 ] ] "descripcion" => array:1 [ "en" => "Enhancement following contrast administration. Absence of enhancement is a non-specific semiological finding. Peripheral incomplete ring-enhancement favours a perivascular pattern caused by multiple sclerosis. Patient with multiple juxtacortical lesions showing typically associated incomplete ring-enhancement." ] ] 11 => array:7 [ "identificador" => "fig0060" "etiqueta" => "Figure 12" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr12.jpeg" "Alto" => 994 "Ancho" => 1600 "Tamanyo" => 185039 ] ] "descripcion" => array:1 [ "en" => "Residual haemorrhage: (A) cortico-subcortical residual haemorrhage suggests amyloid angiopathy; (B) in the basal ganglia, brainstem, and cerebellum suggests AH, and (C) haemorrhage with a history of trauma suggests diffuse axonal injury." ] ] 12 => array:7 [ "identificador" => "fig0065" "etiqueta" => "Figure 13" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr13.jpeg" "Alto" => 1408 "Ancho" => 750 "Tamanyo" => 110746 ] ] "descripcion" => array:1 [ "en" => "Grey matter involvement (basal ganglia). (A) lacunar porencephalic foci, which are likely associated with dilated Virchow–Robin spaces in a patient with uncontrolled AH. (B) Gelatinous cysts in the Virchow–Robin spaces of the lenticulostriated vasculature in a 30-year-old patient with AIDS, who firstly presented with cryptococcosis." ] ] 13 => array:7 [ "identificador" => "fig0070" "etiqueta" => "Figure 14" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr14.jpeg" "Alto" => 912 "Ancho" => 1600 "Tamanyo" => 137518 ] ] "descripcion" => array:1 [ "en" => "Vascular pattern: cerebrovascular risk factors. Patients with AH showing: (A) foci of leukoencephalopathy confluent in the periventricular white matter; (B) involvement of the basal ganglia and the subcortical white matter but no involvement of the subcortical U-fibres; (C) residual haemorrhage in the basal ganglia, brainstem, and cerebellum." ] ] 14 => array:7 [ "identificador" => "fig0075" "etiqueta" => "Figure 15" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr15.jpeg" "Alto" => 564 "Ancho" => 1800 "Tamanyo" => 151023 ] ] "descripcion" => array:1 [ "en" => "Vascular pattern: amyloid angiopathy. Significant changes of microvascular disease in the fronto-parieto-occipital supratentorial white matter with a vascular pattern (left). Gradient-echo sequences (centre) show punctate foci of hemosiderin in the cortico-subcortical interface, predominantly posterior (arrow), suggesting an underlying amyloid angiopathy. On the right, detail of the mural arteriolar deposits of congophilic β-amyloid matter." ] ] 15 => array:7 [ "identificador" => "fig0080" "etiqueta" => "Figure 16" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr16.jpeg" "Alto" => 514 "Ancho" => 1300 "Tamanyo" => 82790 ] ] "descripcion" => array:1 [ "en" => "Vascular pattern: migraine. In patients with migraine (generally with aura), it is common to find frontal punctate lesions in the subcortical white matter with no involvement of subcortical U-fibres (arrows)." ] ] 16 => array:7 [ "identificador" => "fig0085" "etiqueta" => "Figure 17" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr17.jpeg" "Alto" => 575 "Ancho" => 1500 "Tamanyo" => 100739 ] ] "descripcion" => array:1 [ "en" => "Vascular pattern: vasculitis. 63-Year-old woman free of typical cerebrovascular factors with discrete hyperhomocysteinemia and antiphospholipid antibodies. She presented with punctate lesions in the supratentorial white matter with no involvement of the U-fibres (orange arrow) and some areas of a past cortico-subcortical temporoparietal infarct (red arrow). These findings suggested lupic vasculitis." ] ] 17 => array:7 [ "identificador" => "fig0090" "etiqueta" => "Figure 18" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr18.jpeg" "Alto" => 577 "Ancho" => 1750 "Tamanyo" => 114152 ] ] "descripcion" => array:1 [ "en" => "Vascular pattern: dominant autosomic cerebral arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). 50-Year-old patient diagnosed with CADASIL with signs of microvascular disease in the supratentorial white matter and involvement of the anterior temporal poles (arrows)." ] ] 18 => array:7 [ "identificador" => "fig0095" "etiqueta" => "Figure 19" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr19.jpeg" "Alto" => 711 "Ancho" => 1800 "Tamanyo" => 136309 ] ] "descripcion" => array:1 [ "en" => "Perivascular pattern: multiple sclerosis (MS). (A) juxta-cortical lesions; (B) periventricular lesions in the form of Dawson's fingers (left and centre). Confluent lesions with a ridge-like configuration in chronic MS and anterior temporal lesion (right); (C) callosal-septal lesions; (D) peripheral infratentorial lesions; and (E) peripheral incomplete ring-enhancement." ] ] 19 => array:7 [ "identificador" => "fig0100" "etiqueta" => "Figure 20" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr20.jpeg" "Alto" => 1949 "Ancho" => 2635 "Tamanyo" => 408629 ] ] "descripcion" => array:1 [ "en" => "Diagnostic algorithm of the hyperintense punctate images in the white matter (HPIWM), vascular pattern (VP), perivascular pattern (PvP), and non-specific pattern (NsP). ARWMC: ARWMC scale (age-related white matter changes); CVRFs: cardiovascular risk factors; AH: arterial hypertension; DLP: dyslipidemia; DM: diabetes mellitus; CADASIL: dominant autosomic cerebral arteriopathy with subcortical infarcts and leukoencephalopathy; MS: multiple sclerosis." ] ] 20 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vascular pattern \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Not juxtacortical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Sub-U subcortical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Deep bordering \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Periventricular irregular \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Supra->infratentorial \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Supratentorial frontoparietal \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Basal ganglia \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- No enhancement (if not acute) or mild enhancement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Perivascular pattern \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Periventricular ovoid \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Juxtacortical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Fusiform or ovoid \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Dawson's fingers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Supra- and infratentorial \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Large lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-specific pattern \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Deep non-bordering \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- Amorphous, punctate, round \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab209449.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Semiological characteristics." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:59 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "From UBOs to Binswanger's disease: impact of magnetic resonance imaging on vascular dementia research" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G.C. Roman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "1996" "volumen" => "27" "paginaInicial" => "1269" "paginaFinal" => "1273" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8711785" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angiografía cerebral" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.G. Osborn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "2nd ed." "fecha" => "2000" "editorial" => "Marbán Libros S.L." "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathogenesis of leukoaraiosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Pantoni" 1 => "J.H. Garcia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "1997" "volumen" => "28" "paginaInicial" => "652" "paginaFinal" => "659" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9056627" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MR evaluation of developmental venous anomalies: medullary venous anatomy of venous angiomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Lee" 1 => "M.A. Pennington" 2 => "C.M. Kenney III" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "1996" "volumen" => "17" "paginaInicial" => "61" "paginaFinal" => "70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8770251" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Virchow–Robin spaces at MR imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.M. Kwee" 1 => "T.C. Kwee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/rg.274065722" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "2007" "volumen" => "27" "paginaInicial" => "1071" "paginaFinal" => "1086" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17620468" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perivascular spaces in the basal ganglia of the human brain: their relationship to lacunes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Pollock" 1 => "M. Hutchings" 2 => "R.O. Weller" 3 => "E.-T.M. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Anat" "fecha" => "1997" "volumen" => "191" "paginaInicial" => "337" "paginaFinal" => "346" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9418990" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dilated perivascular spaces: hallmarks of mild traumatic brain injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Inglese" 1 => "E. Bomsztyk" 2 => "O. Gonen" 3 => "L.J. Mannon" 4 => "R.I. Grossman" 5 => "H. Rusinek" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "719" "paginaFinal" => "724" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15814911" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Large Virchow–Robin spaces: MR-clinical correlation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.A. Heier" 1 => "C.J. Bauer" 2 => "L. Schwartz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "1989" "volumen" => "10" "paginaInicial" => "929" "paginaFinal" => "936" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2505536" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frequency and location of dilated Virchow–Robin spaces in elderly people: a population-based 3D MR imaging study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.C. Zhu" 1 => "C. Dufouil" 2 => "B. Mazoyer" 3 => "A. Soumaré" 4 => "F. Ricolfi" 5 => "C. Tzourio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3174/ajnr.A2366" "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2011" "volumen" => "32" "paginaInicial" => "709" "paginaFinal" => "713" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21349956" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sandlike appearance of Virchow–Robin spaces in early multiple sclerosis: a novel neuroradiologic marker" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Achiron" 1 => "M. Faibel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2002" "volumen" => "23" "paginaInicial" => "376" "paginaFinal" => "380" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11901003" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F.N. Doubal" 1 => "A.M. MacLullich" 2 => "K.J. Ferguson" 3 => "M.S. Dennis" 4 => "J.M. Wardlaw" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/STROKEAHA.109.564914" "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "2010" "volumen" => "41" "paginaInicial" => "450" "paginaFinal" => "454" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20056930" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dilatation of the Virchow–Robin space is a sensitive indicator of cerebral microvascular disease: study in elderly patients with dementia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T.F. Patankar" 1 => "D. Mitra" 2 => "A. Varma" 3 => "J. Snowden" 4 => "D. Neary" 5 => "A. Jackson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "1512" "paginaFinal" => "1520" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15956523" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Virchow–Robin spaces relate to cerebral small vessel disease severity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.P. Rouhl" 1 => "R.J. van Oostenbrugge" 2 => "I.L. Knottnerus" 3 => "J.E. Staals" 4 => "J. Lodder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00415-008-0777-y" "Revista" => array:6 [ "tituloSerie" => "J Neurol" "fecha" => "2008" "volumen" => "255" "paginaInicial" => "692" "paginaFinal" => "696" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18286319" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Giant tumefactive perivascular spaces" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.L. Salzman" 1 => "A.G. Osborn" 2 => "P. House" 3 => "J.R. Jinkins" 4 => "A. Ditchfield" 5 => "J.A. Cooper" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "298" "paginaFinal" => "305" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15709127" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Developmental dilatation of Virchow–Robin spaces: a genetic disorder?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.L. Bruna" 1 => "I. Martins" 2 => "B. Husson" 3 => "P. Landrieu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pediatrneurol.2009.04.026" "Revista" => array:6 [ "tituloSerie" => "Pediatr Neurol" "fecha" => "2009" "volumen" => "41" "paginaInicial" => "275" "paginaFinal" => "280" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19748047" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Age, hypertension, and lacunar stroke are the major determinants of the severity of age-related white matter changes. The LADIS (Leukoaraiosis and Disability in the Elderly) study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.M. Basile" 1 => "L. Pantoni" 2 => "G. Pracucci" 3 => "K. Asplund" 4 => "H. Chabriat" 5 => "T. Erkinjuntti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000091536" "Revista" => array:6 [ "tituloSerie" => "Cerebrovasc Dis" "fecha" => "2006" "volumen" => "21" "paginaInicial" => "315" "paginaFinal" => "322" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16490940" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Demencias e imagen: lo básico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. Arana Fernández de Moya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rx.2009.09.005" "Revista" => array:6 [ "tituloSerie" => "Radiología" "fecha" => "2010" "volumen" => "52" "paginaInicial" => "4" "paginaFinal" => "17" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19892380" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The challenge of mixed cerebrovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Fisher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1749-6632.2010.05758.x" "Revista" => array:6 [ "tituloSerie" => "Ann N Y Acad Sci" "fecha" => "2010" "volumen" => "1207" "paginaInicial" => "18" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20955421" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Visual rating scales for age-related white matter changes (leukoaraiosis) can the heterogeneity be reduced?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Pantoni" 1 => "M. Simoni" 2 => "G. Pracucci" 3 => "R. Schmidt" 4 => "F. Barkhof" 5 => "D. Inzitari" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "2002" "volumen" => "33" "paginaInicial" => "2827" "paginaFinal" => "2833" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12468777" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MR signal abnormalities at 1.5T in Alzheimer's dementia and normal aging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Fazekas" 1 => "J.B. Chawluk" 2 => "A. Alavi" 3 => "H.I. Hurtig" 4 => "R.A. Zimmerman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2214/ajr.149.2.351" "Revista" => array:6 [ "tituloSerie" => "AJR Am J Roentgenol" "fecha" => "1987" "volumen" => "149" "paginaInicial" => "351" "paginaFinal" => "356" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3496763" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new ratings scale for age-related white matter changes applicable to MRI and CT" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.O. Wahlund" 1 => "F. Barkhof" 2 => "F. Fazekas" 3 => "L. Bronge" 4 => "M. Augustin" 5 => "M. Sjögren" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "2001" "volumen" => "32" "paginaInicial" => "1318" "paginaFinal" => "1322" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11387493" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "National institute of neurological disorders and stroke-Canadian stroke network vascular cognitive impairment harmonization standards" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Hachinski" 1 => "C. Ladecola" 2 => "R.C. Petersen" 3 => "M.M. Breteler" 4 => "D.L. Nyenhuis" 5 => "S.E. Black" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.STR.0000237236.88823.47" "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "2006" "volumen" => "37" "paginaInicial" => "2220" "paginaFinal" => "2241" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16917086" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Barkhof F, Smithuis R. Multiple sclerosis radiology assistant website [publicado 1 Febrer 2007; accessed 15 Ener 2011]. Available from: <a class="elsevierStyleInterRef" href="http://www.radiologyassistant.nl/en/4556dea65db62">http://www.radiologyassistant.nl/en/4556dea65db62</a>." ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathologic correlates of incidental MRI white matter signal hyperintensities" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Fazekas" 1 => "R. Kleinert" 2 => "H. Offenbacher" 3 => "R. Schmidt" 4 => "G. Kleinert" 5 => "F. Payer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "1993" "volumen" => "43" "paginaInicial" => "1683" "paginaFinal" => "1689" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8414012" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Understanding white matter disease. Imaging-pathological correlations in vascular cognitive impairment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Black" 1 => "F. Gao" 2 => "J. Bilbao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/STROKEAHA.108.537704" "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "2009" "volumen" => "40" "paginaInicial" => "S48" "paginaFinal" => "S52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19064767" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuropathology of cerebrovascular diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.N. Hazrati" 1 => "C. Bergeron" 2 => "J. Butany" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Semin Diagn Pathol" "fecha" => "2009" "volumen" => "26" "paginaInicial" => "103" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19891304" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuropathologic correlates of white matter hyperintensities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V.G. Young" 1 => "G.M. Halliday" 2 => "J.J. Kril" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/01.wnl.0000319691.50117.54" "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "2008" "volumen" => "71" "paginaInicial" => "804" "paginaFinal" => "811" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18685136" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Age-related changes in normal-appearing brain tissue and white matter hyperintensities: more of the same or something else?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Spilt" 1 => "T. Geeraedts" 2 => "A.J. de Craen" 3 => "R.G. Westendorp" 4 => "G.J. Blauw" 5 => "M.A. van Buchem" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "725" "paginaFinal" => "729" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15814912" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Not all age-related white matter hyperintensities are the same: a magnetization transfer imaging study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Spilt" 1 => "R. Goekoop" 2 => "R.G. Westendorp" 3 => "G.J. Blauw" 4 => "A.J. de Craen" 5 => "M.A. van Buchem" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2006" "volumen" => "27" "paginaInicial" => "1964" "paginaFinal" => "1968" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17032876" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Magnetization transfer ratio of white matter hyperintensities in subcortical ischemic vascular dementia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Tanabe" 1 => "F. Ezekiel" 2 => "W.J. Jagust" 3 => "B.R. Reed" 4 => "D. Norman" 5 => "N. Schuff" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "1999" "volumen" => "20" "paginaInicial" => "839" "paginaFinal" => "844" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10369354" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging of white matter lesions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Barkhof" 1 => "P. Scheltens" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cerebrovasc Dis" "fecha" => "2002" "volumen" => "13" "paginaInicial" => "S21" "paginaFinal" => "S30" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prominent perivenular spaces in multiple sclerosis as a sign of perivascular inflammation in primary demyelination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y. Ge" 1 => "M. Law" 2 => "J. Herbert" 3 => "R.I. Grossman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "2316" "paginaFinal" => "2319" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16219839" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Debette" 1 => "H.S. Markus" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "BMJ" "fecha" => "2010" "volumen" => "26" "paginaInicial" => "c3666" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Rovira A. Multiple sclerosis and other idiopathic inflamatory-demyelinating diseases of the central nervous system. Programa de formación continuada en radiodiagnóstico. Curso específico 2006–2009. Neurorradiología. Website de radiòlegs de Catalunya [publicado en 2009; accessed 9 Juli 2011]. Available from: <a class="elsevierStyleInterRef" href="http://www.radiolegsdecatalunya.cat/formacio/resums/GE85EN08_R.pdf">http://www.radiolegsdecatalunya.cat/formacio/resums/GE85EN08_R.pdf</a>." ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Headache, migraine, and structural brain lesions and function: population base epidemiology of vascular ageing-MRI study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Kurth" 1 => "S. Mohamed" 2 => "P. Maillard" 3 => "Y. Zhu" 4 => "H. Chabriat" 5 => "B. Mazoyer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2011" "volumen" => "342" "paginaInicial" => "c7357" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21245119" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Idiopathic inflammatory-demyelinating diseases of the central nervous system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.R. Cañellas" 1 => "A.R. Gols" 2 => "J.R. Izquierdo" 3 => "M.T. Subirana" 4 => "X.M. Gairin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00234-007-0216-2" "Revista" => array:6 [ "tituloSerie" => "Neuroradiology" "fecha" => "2007" "volumen" => "49" "paginaInicial" => "393" "paginaFinal" => "409" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17333161" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case 142: Susac syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.K. Demir" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.2502051865" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2009" "volumen" => "250" "paginaInicial" => "598" "paginaFinal" => "602" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19188329" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Distribution of cranial MRI abnormalities in patients with symptomatic and subclinical CADASIL" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Coulthard" 1 => "S.C. Blank" 2 => "K. Bushby" 3 => "R.N. Kalaria" 4 => "D.J. Burn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1259/bjr.73.867.10817040" "Revista" => array:6 [ "tituloSerie" => "Br J Radiol" "fecha" => "2000" "volumen" => "73" "paginaInicial" => "256" "paginaFinal" => "265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10817040" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple sclerosis: the history of the disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T.J. Murray" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2005" "editorial" => "Demos Medical Publishing LLC" "editorialLocalizacion" => "New York" ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extent and distribution of white matter hyperintensities in stroke patients: the Sydney stroke study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W. Wen" 1 => "P.S. Sachdev" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.STR.0000147034.25760.3d" "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "2004" "volumen" => "35" "paginaInicial" => "2813" "paginaFinal" => "2819" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15499036" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedad cerebrovascular. Ictus isquémico. Ictus hemorrágico. Aneurismas y malformaciones vasculares" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Munuera" 1 => "A. Rovira" 2 => "J.L. Caniego" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Radiología esencial. Tomo 2" "paginaInicial" => "1093" "paginaFinal" => "1106" "edicion" => "1st ed." "serieFecha" => "2009" ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MRI criteria for MS in patients with clinically isolated syndromes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X. Montalban" 1 => "M. Tintoré" 2 => "J. Swanton" 3 => "F. Barkhof" 4 => "F. Fazekas" 5 => "M. Filippi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/WNL.0b013e3181cec45c" "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "2010" "volumen" => "74" "paginaInicial" => "427" "paginaFinal" => "434" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20054006" "web" => "Medline" ] ] ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and risk factors of cerebral microbleeds: an update of the Rotterdam scan study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.M. Poels" 1 => "M.W. Vernooij" 2 => "M.A. Ikram" 3 => "A. Hofman" 4 => "G.P. Krestin" 5 => "A. van der Lugt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/STROKEAHA.110.607184" "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "2010" "volumen" => "42" "paginaInicial" => "656" "paginaFinal" => "661" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21307170" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angiitis of the central nervous system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Zuber" 1 => "J. Blustajn" 2 => "S. Arquizan" 3 => "D. Trystam" 4 => "J.L. Mas" 5 => "J.F. Meder" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Neuroradiol" "fecha" => "1999" "volumen" => "26" "paginaInicial" => "101" "paginaFinal" => "117" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10444934" "web" => "Medline" ] ] ] ] ] ] ] ] 44 => array:3 [ "identificador" => "bib0225" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diffuse axonal injury associated with chronic traumatic brain injury: evidence from T2*-weighted gradient-echo imaging at 3T" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Scheid" 1 => "C. Preul" 2 => "O. Gruber" 3 => "C. Wiggind" 4 => "D.Y. von Cramon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2003" "volumen" => "24" "paginaInicial" => "1049" "paginaFinal" => "1056" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12812926" "web" => "Medline" ] ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib0230" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute disseminated encephalomyelitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Politi" 1 => "P. Papanagiotou" 2 => "I.Q. Grunwald" 3 => "C. Roth" 4 => "W. Reith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00117-008-1693-y" "Revista" => array:6 [ "tituloSerie" => "Radiologe" "fecha" => "2008" "volumen" => "48" "paginaInicial" => "553" "paginaFinal" => "559" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18478196" "web" => "Medline" ] ] ] ] ] ] ] ] 46 => array:3 [ "identificador" => "bib0235" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Correlation of MR imaging findings and clinical manifestations in neurosarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Shah" 1 => "G.H. Roberson" 2 => "J.K. Curé" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3174/ajnr.A1470" "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2009" "volumen" => "30" "paginaInicial" => "953" "paginaFinal" => "961" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19193748" "web" => "Medline" ] ] ] ] ] ] ] ] 47 => array:3 [ "identificador" => "bib0240" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MR of CNS sarcoidosis: correlation of imaging features to clinical symptoms and response to treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G.A. Christoforidis" 1 => "E.M. Spickler" 2 => "M.V. Recio" 3 => "B.M. Mehta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "1999" "volumen" => "20" "paginaInicial" => "655" "paginaFinal" => "669" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10319978" "web" => "Medline" ] ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib0245" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Magnetic resonance imaging findings in AIDS patients with central nervous system cryptococcosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Corti" 1 => "M.F. Villafañe" 2 => "R. Negroni" 3 => "A. Arechavala" 4 => "E. Maiolo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Iberoam Micol" "fecha" => "2008" "volumen" => "25" "paginaInicial" => "211" "paginaFinal" => "214" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19071888" "web" => "Medline" ] ] ] ] ] ] ] ] 49 => array:3 [ "identificador" => "bib0250" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cerebral vasculitis: MR imaging and angiographic correlation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.J. Greenan" 1 => "R.I. Grossman" 2 => "H.I. Goldberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiology.182.1.1727311" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "1992" "volumen" => "182" "paginaInicial" => "65" "paginaFinal" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1727311" "web" => "Medline" ] ] ] ] ] ] ] ] 50 => array:3 [ "identificador" => "bib0255" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cerebral amyloid angiopathy: CT and MR imaging findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.P. Chao" 1 => "A.L. Kotsenas" 2 => "D.F. Broderick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/rg.265055090" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "2006" "volumen" => "26" "paginaInicial" => "1517" "paginaFinal" => "1531" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16973779" "web" => "Medline" ] ] ] ] ] ] ] ] 51 => array:3 [ "identificador" => "bib0260" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MRI in migraineurs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Robbins" 1 => "H. Friedman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Headache" "fecha" => "1992" "volumen" => "32" "paginaInicial" => "507" "paginaFinal" => "508" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1468910" "web" => "Medline" ] ] ] ] ] ] ] ] 52 => array:3 [ "identificador" => "bib0265" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging findings of migraine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.M. Cutrer" 1 => "D.F. Black" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1526-4610.2006.00503.x" "Revista" => array:6 [ "tituloSerie" => "Headache" "fecha" => "2006" "volumen" => "46" "paginaInicial" => "1095" "paginaFinal" => "1107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16866714" "web" => "Medline" ] ] ] ] ] ] ] ] 53 => array:3 [ "identificador" => "bib0270" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infarcts in the posterior circulation territory in migraine. The population-based MRI CAMERA study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.C. Kruit" 1 => "L.J. Launer" 2 => "M.D. Ferrari" 3 => "M.A. van Buchem" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/brain/awh542" "Revista" => array:6 [ "tituloSerie" => "Brain" "fecha" => "2005" "volumen" => "128" "paginaInicial" => "2068" "paginaFinal" => "2077" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16006538" "web" => "Medline" ] ] ] ] ] ] ] ] 54 => array:3 [ "identificador" => "bib0275" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arteriopatía cerebral autosómica dominante con infartos subcorticales y leucoencefalopatía (CADASIL). Una revisión" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Navarro" 1 => "F. Díaz" 2 => "L. Muñoz" 3 => "S. Jiménez-Roldán" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurología" "fecha" => "2002" "volumen" => "17" "paginaInicial" => "410" "paginaFinal" => "417" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12396971" "web" => "Medline" ] ] ] ] ] ] ] ] 55 => array:3 [ "identificador" => "bib0280" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The spatial distribution of MR imaging abnormalities in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and their relationship to age and clinical features" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Singhal" 1 => "P. Rich" 2 => "H.S. Markus" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "2481" "paginaFinal" => "2487" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16286388" "web" => "Medline" ] ] ] ] ] ] ] ] 56 => array:3 [ "identificador" => "bib0285" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differential lesion patterns in CADASIL and sporadic subcortical arteriosclerotic encephalopathy: MR imaging study with statistical parametric group comparison" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.P. Auer" 1 => "B. Pütz" 2 => "C. Gössl" 3 => "G. Elbel" 4 => "T. Gasser" 5 => "M. Dichgans" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiology.218.2.r01fe24443" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2001" "volumen" => "218" "paginaInicial" => "443" "paginaFinal" => "451" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11161160" "web" => "Medline" ] ] ] ] ] ] ] ] 57 => array:3 [ "identificador" => "bib0290" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lyme neuroborreliosis: manifestations of a rapidly emerging zoonosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Hildenbrand" 1 => "D.E. Craven" 2 => "R. Jones" 3 => "P. Nemeskal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3174/ajnr.A1579" "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2009" "volumen" => "30" "paginaInicial" => "1079" "paginaFinal" => "1087" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19346313" "web" => "Medline" ] ] ] ] ] ] ] ] 58 => array:3 [ "identificador" => "bib0295" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The spectrum of nervous system involvement in Behçet's syndrome and its differential diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Siva" 1 => "S. Saip" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00415-009-0145-6" "Revista" => array:6 [ "tituloSerie" => "J Neurol" "fecha" => "2009" "volumen" => "256" "paginaInicial" => "513" "paginaFinal" => "529" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19444529" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "identificador" => "xack37812" "titulo" => "Acknowledgements" "texto" => "We would like to thank Susana Boluda, neuropathologist at the Unit of Neuropathology of Bellvitge Hospital, for providing the microphotographs of pathological correlation; Dolores Cocho, neurologist at the Unit of Neurology of Granollers Hospital, for providing the databases of representative cases; and illustrator Txomin Medrano for the anatomy illustrations." ] ] ] "idiomaDefecto" => "en" "url" => "/21735107/0000005400000004/v1_201305061502/S2173510712001000/v1_201305061502/en/main.assets" "Apartado" => array:4 [ "identificador" => "8097" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Updates in radiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735107/0000005400000004/v1_201305061502/S2173510712001000/v1_201305061502/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510712001000?idApp=UINPBA00004N"]

Statistics

Update in Radiology

Imágenes puntiformes hiperintensas en la sustancia blanca: una aproximación diagnóstica

S. Medrano Martorella,

Corresponding author

santimedra@yahoo.es

Corresponding author.

, M. Cuadrado Blázquezb, D. García Figueredob, S. González Ortiza, J. Capellades Fonta

a Servicio de Radiodiagnóstico, Hospital del Mar/IDIMAR-CRC Mar, Barcelona, Spain

b Servicio de Radiodiagnóstico, Hospital de Granollers, Barcelona, Spain

Read

34596

Times
was read the article

9776

Total PDF

24820

Total HTML

Share statistics

 array:23 [
  "pii" => "S2173510712001000"
  "issn" => "21735107"
  "doi" => "10.1016/j.rxeng.2011.09.001"
  "estado" => "S300"
  "fechaPublicacion" => "2012-07-01"
  "aid" => "506"
  "copyright" => "SERAM"
  "copyrightAnyo" => "2011"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Radiologia. 2012;54:321-35"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 27940
    "formatos" => array:2 [
      "HTML" => 24817
      "PDF" => 3123
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S2173510712000997"
    "issn" => "21735107"
    "doi" => "10.1016/j.rxeng.2011.02.003"
    "estado" => "S300"
    "fechaPublicacion" => "2012-07-01"
    "aid" => "377"
    "copyright" => "SERAM"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Radiologia. 2012;54:336-41"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 4336
      "formatos" => array:2 [
        "HTML" => 3356
        "PDF" => 980
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Percutaneous Laser Disc Decompression for lumbar discogenic radicular pain"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "336"
          "paginaFinal" => "341"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Descompresi&#243;n percut&#225;nea discal con l&#225;ser para el tratamiento del dolor lumbo-radicular de origen discal"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 990
              "Ancho" => 992
              "Tamanyo" => 96589
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">L4&#8211;L5 disc puncture under CT guidance&#44; with the tip of the needle positioned at the center of the disc&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46; Duarte, J&#46;C&#46; Costa"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Duarte"
            ]
            1 => array:2 [
              "nombre" => "J&#46;C&#46;"
              "apellidos" => "Costa"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510712000997?idApp=UINPBA00004N"
    "url" => "/21735107/0000005400000004/v1_201305061502/S2173510712000997/v1_201305061502/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2173510712001012"
    "issn" => "21735107"
    "doi" => "10.1016/j.rxeng.2011.09.002"
    "estado" => "S300"
    "fechaPublicacion" => "2012-07-01"
    "aid" => "508"
    "copyright" => "SERAM"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Radiologia. 2012;54:306-20"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 5287
      "formatos" => array:2 [
        "HTML" => 4613
        "PDF" => 674
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Update in Radiology</span>"
      "titulo" => "Role of imaging techniques in the TNM classification of non-small cell bronchogenic carcinoma"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "306"
          "paginaFinal" => "320"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Papel de las t&#233;cnicas de imagen en la nueva clasificaci&#243;n TNM del carcinoma broncog&#233;nico no microc&#237;tico"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0040"
          "etiqueta" => "Figure 8"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr8.jpeg"
              "Alto" => 1136
              "Ancho" => 1993
              "Tamanyo" => 241894
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Epidermoid carcinoma &#40;not shown&#41; in the right upper lobe in a 67-year-old patient&#46; &#40;a&#41; Axial multidetector computed tomography &#40;MDCT&#41; image showed a nodular thickening of the right adrenal gland &#40;solid arrow&#41; with signal loss in the opposed-phase gradient-echo sequence &#40;b&#41;&#44; without hypersignal in the T2 sequence with fat suppression &#40;c&#41; and homogeneous enhancement after gadolinium administration&#46; The characteristics of the lesion were consistent with an adenoma&#46; Apart from this&#44; the left adrenal gland was irregularly thickened &#40;open arrow&#41; on MDCT &#40;e&#41;&#44; without signal loss in opposed-phase imaging &#40;f&#41; but with hypersignal on T2 sequences &#40;g&#41;&#44; and showing peripheral and irregular enhancement&#46; PET&#8211;CT and FNPA confirmed the diagnosis of metastasis &#40;not shown&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46; Cano Alonso, L&#46; Herr&#225;iz Hidalgo, E&#46; &#193;lvarez Moreno, C&#46; Paniagua Correa, V&#46; Mart&#237;nez de Vega"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Cano Alonso"
            ]
            1 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Herr&#225;iz Hidalgo"
            ]
            2 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "&#193;lvarez Moreno"
            ]
            3 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Paniagua Correa"
            ]
            4 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Mart&#237;nez de Vega"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510712001012?idApp=UINPBA00004N"
    "url" => "/21735107/0000005400000004/v1_201305061502/S2173510712001012/v1_201305061502/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Update in Radiology</span>"
    "titulo" => "Hyperintense punctiform images in the white matter&#58; A diagnostic approach"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "321"
        "paginaFinal" => "335"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "S&#46; Medrano Martorell, M&#46; Cuadrado Bl&#225;zquez, D&#46; Garc&#237;a Figueredo, S&#46; Gonz&#225;lez Ortiz, J&#46; Capellades Font"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "S&#46;"
            "apellidos" => "Medrano Martorell"
            "email" => array:1 [
              0 => "santimedra&#64;yahoo&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Cuadrado Bl&#225;zquez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "D&#46;"
            "apellidos" => "Garc&#237;a Figueredo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "S&#46;"
            "apellidos" => "Gonz&#225;lez Ortiz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Capellades Font"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Radiodiagn&#243;stico&#44; Hospital del Mar&#47;IDIMAR-CRC Mar&#44; Barcelona&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Radiodiagn&#243;stico&#44; Hospital de Granollers&#44; Barcelona&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Im&#225;genes puntiformes hiperintensas en la sustancia blanca&#58; una aproximaci&#243;n diagn&#243;stica"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0075"
        "etiqueta" => "Figure 15"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr15.jpeg"
            "Alto" => 564
            "Ancho" => 1800
            "Tamanyo" => 151023
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Vascular pattern&#58; amyloid angiopathy&#46; Significant changes of microvascular disease in the fronto-parieto-occipital supratentorial white matter with a vascular pattern &#40;left&#41;&#46; Gradient-echo sequences &#40;centre&#41; show punctate foci of hemosiderin in the cortico-subcortical interface&#44; predominantly posterior &#40;arrow&#41;&#44; suggesting an underlying amyloid angiopathy&#46; On the right&#44; detail of the mural arteriolar deposits of congophilic &#946;-amyloid matter&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The interpretation of multiple hyperintense punctate images in the white matter in T2-weighted sequences&#44; which are daily reported at magnetic resonance imaging &#40;MRI&#41; of adult brains&#44; plays a major role in the routine practice of neuroradiologists&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A parallelism can be established between the commonly used term <span class="elsevierStyleItalic">unidentified bright objects</span> &#40;UBO&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and the term <span class="elsevierStyleItalic">hyperintense punctate images in the white matter</span> &#40;HPIWM&#41;&#44; which is presented in this paper&#46; Accordingly&#44; HPIWM is a semiological entity revealing at least five solitary hyperintense foci of up to 1<span class="elsevierStyleHsp" style=""></span>cm in diameter on T2-weighted sequences&#44; with or without confluent lesions with an overall diameter &#62;1<span class="elsevierStyleHsp" style=""></span>cm&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The main goal of this paper is to simplify the radiologist&#39;s task when dealing with cases of HPIWM&#44; so that radiologists can categorize the findings under a predominant pattern and make a more accurate diagnosis&#46; This paper proposes three main HPIWM patterns based on the semiological characteristics&#58; a vascular pattern &#40;VP&#41;&#44; which represents microvascular involvement &#40;usually arteriolar&#41;&#59; a perivascular pattern &#40;PvP&#41;&#44; which represents inflammatory disease &#40;particularly demyelinating disease&#41;&#59; and a non-specific pattern &#40;NsP&#41;&#44; which usually represents microvascular disease&#46; To make a diagnosis&#44; the predominant semiological pattern should be considered together with the clinical manifestations of patient and the epidemiologic data&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Basic anatomy of brain microcirculation</span><p id="par0020" class="elsevierStylePara elsevierViewall">The brain microcirculation consists of a vascular network with a very complex anatomy that varies across subjects&#46; To understand the HPIWM patterns suggested&#44; the basic aspects of brain microvascular anatomy will be addressed&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Arterial microvascular system</span><p id="par0025" class="elsevierStylePara elsevierViewall">The cortical arteries cross the cerebral cortex and penetrate the white matter perpendicularly to the cortical surface&#44; forming the terminal pial or medullary arterioles up to 4&#8211;5<span class="elsevierStyleHsp" style=""></span>cm long&#46; Along their course&#44; they give off short cortical branches that supply the entire cerebral cortex and the fibres of the juxtacortical white matter &#40;3&#8211;4<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; also called <span class="elsevierStyleItalic">U-fibres</span>&#46; The cortical arteries establish multiple anastomoses&#44; which provide the cerebral cortex with a rich arteriolar network&#46; When running deep into the white matter&#44; pial arteries establish very few capillary anastomoses with the neighbouring pial arterioles&#44; forming relatively independent arteriolar metabolic units&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The deep subependymal arteries&#44; which arise from the choroid arteries&#44; give off penetrating branches to the white matter&#44; although with shorter course than that of the pial arteries&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">There is a second terminal system of cortical and subependymal arteries &#40;lenticulostriated and thalamic perforating arteries&#41; that supplies the basal ganglia &#40;BG&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The superficial and deep arteriolar systems &#40;pial penetrating arteries and subependymal arteries&#41; hardly anastomose with each other&#46; For this reason&#44; the parenchyma located on the bordering zone between the superficial and the deep vasculature is less vascularized&#46; In contrast&#44; the U-fibres are more and better vascularized than the rest of the white matter and BG<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Venous microvascular system</span><p id="par0045" class="elsevierStylePara elsevierViewall">The cerebral venules&#44; also known as medullary venules&#44; are divided into two large groups&#58; superficial medullary venules&#44; which are short venous channels draining to the cortical surface from about 1 or 2<span class="elsevierStyleHsp" style=""></span>cm below the cerebral cortex&#59; and the deep medullary venules&#44; which are longer channels that drain perpendicularly to the ventricular surface towards the subependymal veins&#46; There is a third group including transcerebral venules&#44; less abundant and that connect both systems<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Perivascular space</span><p id="par0050" class="elsevierStylePara elsevierViewall">The arterial system runs parallel to the venous system&#46; The perivascular space surrounds the wall of arteries and arterioles &#40;Virchow&#8211;Robin space&#41; and veins and venules &#40;perivenular space&#41; from the subarachnoid space along their intraparenchymatous course&#46; The superficial or cortical arterioles are surrounded by one layer of leptomeninges that separates the vascular surface from the periarteriolar space&#46; The parenchymatous surface of this space is limited by the pia mater&#46; The perivascular space of the penetrating arterioles of the BG is delimited by the two layers of leptomeninges that surround their endothelium&#46; Apparently there is direct communication of the superficial and deep perivenular space with the subpial space&#44; with no leptomeningeal layers separating them &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">&#8220;Normal&#8221; hyperintense punctate images in the white matter</span><p id="par0055" class="elsevierStylePara elsevierViewall">The presence of a few hyperintense punctate foci in the cerebral white matter at MRI is a very common finding that can be regarded as insignificant in most of the cases&#46; These bright dots&#44; considered as <span class="elsevierStyleItalic">normal</span>&#44; can be a manifestation of dilated perivascular spaces or small gliotic or lacunar ischemic foci&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">At conventional MRI&#44; perivascular spaces appear dilated &#40;dPVS&#41; in 13&#37; of healthy adults and in only 3&#37; of children between 20 months and 16 years of age&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> In a recent multicentre observational study&#44; cerebral MRI studies using high-resolution 3D sequences of 1818 healthy individuals aged over 65 &#40;dementia-free and with no history of cerebral infarction&#41; were reviewed&#46; dPVS were detected in all patients and dPVS larger than 3<span class="elsevierStyleHsp" style=""></span>mm were detected in approximately one third of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> dPVS appear as linear or fusiform foci with similar signal to that of the cerebrospinal fluid in all sequences &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Small perivascular spaces &#40;&#60;2<span class="elsevierStyleHsp" style=""></span>mm&#41; have been regarded as an anatomic variant&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> whereas larger &#40;&#62;2<span class="elsevierStyleHsp" style=""></span>mm&#41; PVS have been associated with ageing&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> dementia&#44; early inflammatory stages in multiple sclerosis&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and inflammatory reaction in traumatic brain injury&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> A number of recent studies have concluded that dPVS are associated with lacunar ischemic lesions&#44; and thus&#44; this finding can be considered as an indicator of cerebral small vessel disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;13</span></a> As an exception&#44; perivascular spaces may be significantly dilated&#44; typically in the mesencephalothalamic region&#46; They can cause a significant mass effect and hydrocephalus and need to be distinguished from other tumefactive cystic lesions&#46; These giant perivascular spaces are on many occasions incidentally discovered and their presence not always correlates with the clinical manifestations&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;14</span></a> Some studies have reported a poor association with different degrees of developmental delay&#44; headaches&#44; behaviour anomalies&#44; and nonspecific epilepsy&#44; as well as benign macrocephaly in the paediatric population<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The appearance of ischemic-like lacunar foci in the periventricular and subcortical white matter is a <span class="elsevierStyleItalic">physiological</span> process because age is a cerebrovascular risk factor itself&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> Abnormalities of the white matter are almost ubiquitous &#40;95&#37;&#41; in the population over the age of 65 years&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">There are different visual rating scales for age-related white matter changes &#40;leukoaraiosis&#41; showing a good correlation between them&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> One of the best known is the Fazekas scale&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> which was integrated in the ARWMC scale &#40;<span class="elsevierStyleItalic">age-related white matter changes</span>&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> recommended when lesions of the white matter are not to be quantified by CT or MRI&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> This is a four-grade rating scale for punctate microvascular lesions in the white matter&#46; Absence of lesions corresponds to grade 0&#59; presence of non-confluent focal lesions corresponds to grade 1&#59; initially confluent lesions correspond to grade 2&#59; diffuse confluent lesions correspond to grade 3 &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46; Based on this scale&#44; a lesion is considered normal &#40;attributed to ageing&#41; and classified as grade 1&#44; grade 2 is considered abnormal in patients &#60;75 years&#44; and grade 2 is considered abnormal in any age group&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">There is a number of studies on pathologic and imaging correlation<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;27</span></a> using magnetization transfer &#40;MT&#41; imaging studies that compare magnetization transfer ratios &#40;MTR&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#8211;30</span></a> These studies attempt to elucidate the nature of these lesions&#44; and report differences between lesions in the perivascular white matter and subcortical lesions&#46; Outcomes suggest that ageing induces anomalies in the ependymal membrane&#44; which causes filtration of the cerebrospinal fluid&#46; This filtration leads to gliosis and focal demyelinization of the parenchyma&#46; In addition&#44; subependymal penetrating microcirculation degenerates&#44; which means that there is also a certain ischemic component associated&#44; particularly in those cases in which periventricular leukoencephalopathy exhibits irregular borders&#46; Apart from this&#44; subcortical white matter lesions are essentially ischemic in nature due to the senile degeneration of the microcirculation&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;30</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">&#8220;Abnormal&#8221; hyperintense punctate images in the white matter</span><p id="par0080" class="elsevierStylePara elsevierViewall">When the HPIWM is pathological&#44; it may be indicative of an acquired or inherited disease&#46; Among the acquired diseases of the white matter&#44; microvascular hypoxicoischemic disease is by far the most common&#44; no matter whether atherothrombotic&#44; embolic or caused by cerebrovascular risk factors &#40;CVRFs&#41;&#46; The acquired origin should be considered the first diagnostic option&#44; even in the absence of typical CVRFs&#44; unless there are clinical and analytic evidence suggestive of a different aetiology&#46; Multiple sclerosis &#40;MS&#41; is the second most common disorder&#44; with vasculitis&#44; infection&#44; intoxication&#44; and trauma &#40;among other causes&#41; trailing far behind&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> A large number of patients with a very low vascular risk present with lesions of microvascular appearance for which there is relatively often no alternative or final diagnosis&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">With respect to inherited disorders&#44; leukodystrophic diseases are a group of rare diseases&#46; Although they usually occur in the paediatric age&#44; they can present in adult age&#46; They are metabolic diseases that usually affect the white matter in a quite symmetric and extensive &#40;not punctate&#41; manner&#44; and usually damage the brainstem and the cerebellum&#46; An exception is mitochondrial diseases&#44; which cause more asymmetric lesions&#44; and normally affect the grey matter&#46; In adults&#44; the most common are metachromatic leukodystrophy&#44; globoid cell leukodystrophy&#44; adrenomyeloneuropathy&#44; mitochondrial disorders&#44; vanishing white matter&#44; and cerebrotendinous xanthomatosis&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a></p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Basic pathophysiology</span><p id="par0090" class="elsevierStylePara elsevierViewall">One possible mechanism of damage of the white matter is the primary involvement of an arteriole or cerebral venule&#44; which compromises the blood supply of the parenchyma that depends on them&#44; and induces a lesion&#46; White matter microvascular disease encompasses a wide range of conditions&#58; hypoxia-ischemia&#44; granulomatous or nongranulomatous inflammation&#44; infection&#44; disease caused by substance deposit&#44; toxins&#44; metabolic disease&#44; traumatism&#44; etc&#46; Another possible pathophysiological mechanism of leukoencephalopathy is cell infiltration or deposition of pathologic substances in the perivascular space that can also manifest radiologically as focal lesions in the white matter&#46; They have a non-infectious inflammatory aetiology &#40;as is the case of MS or other demyelinating diseases&#44; some types of vasculitis&#44; and some granulomatous diseases&#41;&#44; an atypical infectious aetiology &#40;Lyme&#39;s disease&#44; cryptococcosis&#44; parenchymatous cysticercosis&#41;&#44; a metabolic aetiology &#40;mucopolysaccharidosis&#41; or a traumatic aetiology &#40;diffuse axonal injury&#41;&#46; Both pathophysiological mechanisms may co-occur in one same disease&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">White matter disease can be approached by taking into account the anatomy of cerebral microcirculation and its interstitium&#44; specifically by determining the most affected elements in the different leukoencephalopathic groups&#46; In this respect&#44; our goal is to get insights into the pathophysiology of the disease underlying the HPIWM by identifying the predominant semiological pattern&#46; Three main patterns can be defined on the basis of several semiological elements&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">A vascular pattern &#40;VP&#41; or microvascular pattern&#44; which is usually caused by an arteriolar lesion&#44; and is the most prevalent &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">A perivascular pattern &#40;PvP&#41;&#44; which is usually caused by perivascular inflammation&#44; among other less common causes&#46; The paradigm of this pattern is MS&#44; for which an autoimmune perivenular inflammation has been reported that causes demyelinization<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>B&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0110" class="elsevierStylePara elsevierViewall">A non-specific pattern &#40;NsP&#41;&#44; when neither of the previous patterns can be identified&#44; and which is normally caused by microvascular disease&#46;</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Semiological elements in hyperintense punctate lesions in the white matter</span><p id="par0115" class="elsevierStylePara elsevierViewall">For the radiologic approach of a case of HPIWM&#44; the semiological elements to be analysed are distribution and location&#44; shape&#44; size&#44; enhancement after contrast administration&#44; presence of haemorrhage or microhaemorrhage&#44; and grey matter involvement&#46; Description of each of these elements may help identify one of the three semiological patterns suggested&#44; thus facilitating an adequate differential diagnosis for each case&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Distribution and location</span><p id="par0120" class="elsevierStylePara elsevierViewall">HPIWM may present with a predominantly supratentorial&#44; infratentorial or supra- and infratentorial distribution&#46; As shall be shown below&#44; the presence of lesions with an essentially supratentorial distribution generally suggests small vessel disease as a first option&#44; which favours a VP &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46; This suggestion is further supported by a predominantly frontoparietal distribution&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">Supratentorial distribution concerns four large areas&#58; subcortical area&#44; periventricular area&#44; deep area&#44; and corpus callosum &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Fig&#46; 8</a>&#41;&#46;</p><elsevierMultimedia ident="fig0040"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">A subcortical lesion can be located either in direct contact with the cerebral cortex &#40;juxtacortical&#41; thus affecting subcortical U-fibres of the white matter&#44; or can be located inside these fibres&#44; which would not be affected&#46; In this latter case&#44; the lesion is classified as <span class="elsevierStyleItalic">sub-U subcortical</span>&#46; A sub-U subcortical lesion suggests a VP&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> whereas a juxtacortical lesion is more suggestive of a PvP&#44; which is typically associated with MS &#40;a PvP is present in one third of MS cases&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">A lesion will be regarded as periventricular when it is in contact or virtually in contact &#40;closer than 1<span class="elsevierStyleHsp" style=""></span>cm&#41;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> with the ependymal surface&#46; Both microvascular and perivascular lesions can have a periventricular location&#44; the shape of the lesion being the key semiological element&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">The deep region is located between the subcortical and periventricular regions&#46; The deep region is classified as bordering when located in a border zone between two vascular areas&#44; which is indicative of a VP&#44; or as non-bordering when not clearly located in a border zone&#44; which is indicative of an NsP&#46; The corpus callosum is a specific location as well&#44; as in some other diseases&#44; such as MS&#8212;typically in the callosal-septal interface&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#8212;in the Susac syndrome<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#44;36&#44;37</span></a> or in the cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy &#40;CADASIL&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> among others&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Infratentorial lesions can have a peripheral location&#44; in contact with the surface of the parenchyma&#44; or a central location&#44; with no involvement of the surface&#46; A central lesion is typically associated with a VP&#44; whereas a peripheral lesion is typically associated with a PvP<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Morphology</span><p id="par0150" class="elsevierStylePara elsevierViewall">There are several lesion types according to their shape&#58; oval or fusiform&#44; punctate or roundish&#44; and amorphous &#40;<a class="elsevierStyleCrossRef" href="#fig0045">Fig&#46; 9</a>&#41;&#46; Punctate&#44; roundish&#44; and amorphous lesions are non-specific&#44; whereas oval or fusiform lesions usually have a distribution parallel to the cerebral microcirculation&#44; and thus&#44; they normally feature a PvP&#46; Oval or fusiform periventricular lesions in a radial pattern and perpendicular to the longitudinal axis of the lateral ventricles are quite a common feature of MS&#46; They are known as <span class="elsevierStyleItalic">Dawson&#39;s fingers</span>&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> after the neuropathologist James Dawson&#44; who described finger-like venular and perivenular inflammatory cells in MS patients&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Confluence of these lesions makes up a ridge-like configuration&#44; which is also associated with MS&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> CVRF-induced microvascular periventricular leukoencephalopathy presents with typically more irregular borders&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;40</span></a></p><elsevierMultimedia ident="fig0045"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Size</span><p id="par0155" class="elsevierStylePara elsevierViewall">Localization of an isolated lesion &#40;not several confluent lesions&#41; &#62;10&#8211;15<span class="elsevierStyleHsp" style=""></span>mm in size is suggestive of a PvP &#40;lacunar infarctions are acknowledged to reach 15<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> Smaller lesions are non-specific&#44; and can be indicative either of a microvascular or a perivascular lesion &#40;<a class="elsevierStyleCrossRef" href="#fig0050">Fig&#46; 10</a>&#41;&#46;</p><elsevierMultimedia ident="fig0050"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Enhancement after contrast administration</span><p id="par0160" class="elsevierStylePara elsevierViewall">Although a non-specific finding&#44; the absence of enhancement on leukoencephalopathic foci is suggestive of an inactive stage of the disease&#46; In contrast&#44; the active inflammatory stage of the disease usually involves an increase in permeability or absence of the blood&#8211;brain barrier and gadolinium enhancement of the lesion&#46; Punctate&#44; peripheral &#40;in complete or incomplete ring&#41; or central &#40;homogeneous or heterogeneous&#41; contrast enhancement can be observed&#46; Enhancing patterns are generally a non-specific finding&#44; except for peripheral incomplete ring-enhancement&#44; which has been reported as a finding typically associated with MS&#44;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#44;36</span></a> and thus&#44; suggestive of a PvP &#40;<a class="elsevierStyleCrossRef" href="#fig0055">Fig&#46; 11</a>&#41;&#46;</p><elsevierMultimedia ident="fig0055"></elsevierMultimedia><p id="par0165" class="elsevierStylePara elsevierViewall">When an image is suspicious of MS&#44; the current diagnostic criteria of the MAGNIMS &#40;magnetic imaging in MS&#41;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> group do not require gadolinium enhancement as part of the diagnosis for dissemination in space&#46; However&#44; one enhancing lesion among non-enhancing lesions in the same MRI study is enough to determine dissemination in time&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">In the follow-up of the disease&#44; many authors opt for contrast administration for the assessment of active inflammation and response to treatment&#46; The number of enhancing lesions may also help predict the prognosis of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Haemorrhage or microhaemorrhage</span><p id="par0175" class="elsevierStylePara elsevierViewall">At MRI&#44; images of microbleeding are associated with HPIWM in at least 18&#37; of the population over 60 years of age&#46; HPIWM are present in over 95&#37; of the population over 65 years of age&#46; These data provide further evidence of the mixed microvascular disease&#44; which shares a pathophysiological origin with white matter disease and microbleeding&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> When a VP with foci of microbleeding is observed in T2&#42;&#44; two pathologic entities are possible&#58; arterial hypertension &#40;AH&#41; and amyloid angiopathy &#40;AA&#41;&#46; Involvement of the deep region of the BG and infratentorial involvement suggest hypertensive or arteriosclerotic microangiopathy&#44; whereas a peripheral location in the cerebral cortex or lobes of the bleeding is typically associated with AA<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0060">Fig&#46; 12</a>&#41;&#46;</p><elsevierMultimedia ident="fig0060"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">Patients with vasculitis present with foci of cerebral bleeding associated with white matter microvascular-like lesions and cortical ischemic lesions appearing at the onset or secondary to infarct transformation&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Another cause of HPIWM with residual bleeding is the diffuse axonal injury associated with a high-energy traumatic injury&#46; Residual foci of leukoencephalopathy with traces of haemosiderin are detected at the grey matter-white matter border&#44; mainly located in the frontal lobe and typically in the region of basal nuclei and in the splenium of the corpus callosum<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0060">Fig&#46; 12</a>&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Grey matter involvement</span><p id="par0190" class="elsevierStylePara elsevierViewall">Most HPIWM cases are associated with cortical lesions or lesions of the BG region&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Co-presence of lesions in the cerebral cortex and multiple bright foci in the white matter is a non-specific finding&#46; In patients with vasculitis-induced microvascular disease&#44; it is not uncommon to detect peripheral lesions with cortical involvement&#44; which usually represent areas of ischemic infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> However&#44; they are not readily visualized in conventional MRI sequences&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">GB involvement typically occurs in patients with hypertense or arteriosclerotic microangiopathy<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0065">Fig&#46; 13</a>&#41;&#44; and is very rare in MS patients&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> In patients with acute disseminated encephalomielities &#40;ADEM&#41;&#44; who may present with lesions indistinguishable from those of MS&#44; the BG region and the spinal cord are usually affected&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36&#44;46</span></a> Diverse forms of vasculitis &#40;systemic lupus erythematosus &#91;SLE&#93;&#44; Beh&#231;et&#39;s disease&#44; etc&#46;&#41; and neurosarcoidosis can affect the BG&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">44&#44;47&#44;48</span></a> Immunocompromised patients with cryptococcosis typically present with gelatinous cysts in the perivascular space of the lenticulostriated and thalamic perforating arterioles of the BG&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a></p><elsevierMultimedia ident="fig0065"></elsevierMultimedia></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Differential diagnosis</span><p id="par0205" class="elsevierStylePara elsevierViewall">The general features of each pattern can be defined by considering each of the semiological elements described &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; An adequate differential diagnosis can be made by identifying the predominant pattern and the specific aspects of each case&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Vascular pattern</span><p id="par0210" class="elsevierStylePara elsevierViewall">A vascular pattern in microvascular hypoxic-ischemic disease secondary to CVRFs &#40;especially AH&#44; dyslipidemia&#44; and diabetes&#41; is associated with a great number of lesions that are normally identified in the majority of semiological findings described by this pattern&#46; AH produces traces of haemosiderin&#44; which can be observed in T2&#42;-weighted sequences&#44; particularly in the corpus striatum&#44; thalami&#44; cerebellum&#44; and brainstem &#40;<a class="elsevierStyleCrossRef" href="#fig0070">Fig&#46; 14</a>&#41;&#46;</p><elsevierMultimedia ident="fig0070"></elsevierMultimedia><p id="par0215" class="elsevierStylePara elsevierViewall">As already mentioned&#44; microvascular involvement in AA is associated with a VP&#44; typically manifested as cortical foci of peripheral microhaemorrhage or areas of haemorrhage in cerebral lobes<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;50&#44;51</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0075">Fig&#46; 15</a>&#41;&#46;</p><elsevierMultimedia ident="fig0075"></elsevierMultimedia><p id="par0220" class="elsevierStylePara elsevierViewall">Studies with migraine patients have reported microvascular-like HPIWM&#44;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">52&#44;53</span></a> predominantly frontal or located in the semioval centres<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0080">Fig&#46; 16</a>&#41;&#46; A recent study with 780 participants confirms this association both in patients with migraine headache and in patients presenting with other headache disorders&#44; especially tension-related headaches&#46; Prevalence for tension-related and migraine headaches was 34&#37; and 32&#37;&#44; respectively&#44; and both were much higher than prevalence for HPIWM in the controls &#40;7&#46;4&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Migraine with aura has been shown to have a stronger association with clinical or subclinical ischemic infarcts&#44; particularly in the posterior circulation territory &#40;cerebellum&#44; protuberance&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">54</span></a> Additionally&#44; and irrespective of the headache type&#44; the presence of cerebral abnormalities does not seem to be associated with cognitive impairment&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a></p><elsevierMultimedia ident="fig0080"></elsevierMultimedia><p id="par0225" class="elsevierStylePara elsevierViewall">Most blood vessels affected by vasculitis in the central nervous system present with HPIWM typical of a VP&#44; with a certain subcortical prevalence and associated with cortical ischemic lesions and foci of intraparenchymatous bleeding appearing at the onset or secondary to infarct transformation&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> Traces of peripheral microhaemorrhage can be found in the BG due to septic vasculitis<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> and vasculitis caused by vasoactive drugs&#44; such as cocaine and alkaloid derivatives&#44; amphetamine&#44; ephedrine and phenylpropanolamine<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">44&#44;50</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0085">Fig&#46; 17</a>&#41;&#46;</p><elsevierMultimedia ident="fig0085"></elsevierMultimedia><p id="par0230" class="elsevierStylePara elsevierViewall">CADASIL integrates all features typical of VP associated with bilateral temporal involvement of the anterior poles&#44; the external capsules&#44; and the corpus callosum in the callosal-septal interface<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">55&#8211;57</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0090">Fig&#46; 18</a>&#41;&#46;</p><elsevierMultimedia ident="fig0090"></elsevierMultimedia><p id="par0235" class="elsevierStylePara elsevierViewall">In short&#44; a leukoencephalopathy can be caused by HPIWM with VP if the patient presents with CVRFs&#46; Otherwise&#44; the differential diagnosis focuses on other causes of microvascular abnormalities&#44; such as AA&#44; headache&#44; toxic-metabolic diseases&#44; some forms of vasculitis and CADASIL&#44; among others&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Perivascular pattern</span><p id="par0240" class="elsevierStylePara elsevierViewall">HPIWM with a perivascular pattern is suggestive of MS as the first diagnostic option&#46; The most characteristic semiological findings are&#58; juxtacortical and periventricular ovoid lesions in the form of Dawson&#39;s fingers&#44; typically in contact with the inferior aspect of the corpus callosum &#40;callosal-septal lesions&#41; or adjacent to the anterior aspect of the temporal horn&#59; peripheral infratentorial lesions adjacent to the floor of the fourth ventricle&#44; in the middle cerebellar peduncles and in the brainstem<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0095">Fig&#46; 19</a>&#41;&#46;</p><elsevierMultimedia ident="fig0095"></elsevierMultimedia><p id="par0245" class="elsevierStylePara elsevierViewall">If other clinical or analytic indications favour MS&#44; the patient is treated as having MS before the final diagnosis of dissemination in space and time&#44; in consonance with the MAGNIMS criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> If the clinical setting is not suggestive of MS&#44; the differential diagnosis will include other diseases with a likely autoimmune aetiology&#44; such as atypical MS&#44; ADEM&#44; SLE&#44; Sj&#246;gren&#39;s disease&#44; and sarcoidosis&#44;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">47&#44;48</span></a> infections such as Lyme&#39;s disease<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">58</span></a> and cryptococcosis&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> some forms of vasculitis&#44; such as Beh&#231;et&#39;s disease&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">59</span></a> and metabolic diseases&#44; such as mucopolysaccharidosis&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Non-specific pattern</span><p id="par0250" class="elsevierStylePara elsevierViewall">Leukoencephalopathy can be caused by HPIWM with an NsP if the patient presents with CVRFs&#46; Otherwise&#44; the differential diagnosis firstly focuses on causes of atypical microvascular disease&#44; and secondly&#44; on uncommon causes of perivascular disease&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">The summary chart in <a class="elsevierStyleCrossRef" href="#fig0100">Fig&#46; 20</a> suggests a diagnostic algorithm to be used in an HPIWM case&#46; This algorithm may help make an adequate differential diagnosis once the predominant pattern has been identified&#46;</p><elsevierMultimedia ident="fig0100"></elsevierMultimedia></span></span></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0260" class="elsevierStylePara elsevierViewall">This study proposes a practical and simple diagnostic tool on the basis of three main semiological patterns of hyperintense punctate images in the white matter&#58; a vascular pattern&#44; a perivascular pattern&#44; and a non-specific pattern&#46; These patterns are established based on the anatomy of cerebral microcirculation&#46; Identifying the predominant semiological pattern enables to narrow down the etiological diagnosis&#46; Most bright dots visualized at MRI of the brain have a vascular aetiology&#46; MS is the most common cause of PvP&#46; An NsP is more likely to be an atypical manifestation of vascular aetiology&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Authorship</span><p id="par0265" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1&#46;</span><p id="par0270" class="elsevierStylePara elsevierViewall">Responsible for the integrity of the study&#58; SM&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#46;</span><p id="par0275" class="elsevierStylePara elsevierViewall">Conception of the study&#58; SM&#44; MC and DG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3&#46;</span><p id="par0280" class="elsevierStylePara elsevierViewall">Design of the study&#58; SM&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">4&#46;</span><p id="par0285" class="elsevierStylePara elsevierViewall">Acquisition of data&#58; SM&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">5&#46;</span><p id="par0290" class="elsevierStylePara elsevierViewall">Analysis and interpretation of data&#58; SM&#44; MC&#44; DG&#44; JC and SG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">6&#46;</span><p id="par0295" class="elsevierStylePara elsevierViewall">Statistical analysis&#58; N&#47;A&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">7&#46;</span><p id="par0300" class="elsevierStylePara elsevierViewall">Bibliographic search&#58; SM&#44; MC and DG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">8&#46;</span><p id="par0305" class="elsevierStylePara elsevierViewall">Drafting of the manuscript&#58; SM&#44; MC and DG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">9&#46;</span><p id="par0310" class="elsevierStylePara elsevierViewall">Critical review with intellectually relevant contributions&#58; SM&#44; MC&#44; DG&#44; JC and SG&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">10&#46;</span><p id="par0315" class="elsevierStylePara elsevierViewall">Approval of the final version&#58; SM&#44; MC&#44; DG&#44; JC and SG&#46;</p></li></ul></p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interests</span><p id="par0320" class="elsevierStylePara elsevierViewall">The author declares no conflicts of interests&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:2 [
          "identificador" => "xres122028"
          "titulo" => "Abstract"
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec109315"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres122029"
          "titulo" => "Resumen"
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec109316"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Basic anatomy of brain microcirculation"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Arterial microvascular system"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Venous microvascular system"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Perivascular space"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "&#8220;Normal&#8221; hyperintense punctate images in the white matter"
        ]
        7 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "&#8220;Abnormal&#8221; hyperintense punctate images in the white matter"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Basic pathophysiology"
            ]
            1 => array:3 [
              "identificador" => "sec0045"
              "titulo" => "Semiological elements in hyperintense punctate lesions in the white matter"
              "secciones" => array:6 [
                0 => array:2 [
                  "identificador" => "sec0050"
                  "titulo" => "Distribution and location"
                ]
                1 => array:2 [
                  "identificador" => "sec0055"
                  "titulo" => "Morphology"
                ]
                2 => array:2 [
                  "identificador" => "sec0060"
                  "titulo" => "Size"
                ]
                3 => array:2 [
                  "identificador" => "sec0065"
                  "titulo" => "Enhancement after contrast administration"
                ]
                4 => array:2 [
                  "identificador" => "sec0070"
                  "titulo" => "Haemorrhage or microhaemorrhage"
                ]
                5 => array:2 [
                  "identificador" => "sec0075"
                  "titulo" => "Grey matter involvement"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "sec0080"
              "titulo" => "Differential diagnosis"
              "secciones" => array:3 [
                0 => array:2 [
                  "identificador" => "sec0085"
                  "titulo" => "Vascular pattern"
                ]
                1 => array:2 [
                  "identificador" => "sec0090"
                  "titulo" => "Perivascular pattern"
                ]
                2 => array:2 [
                  "identificador" => "sec0095"
                  "titulo" => "Non-specific pattern"
                ]
              ]
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0100"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0105"
          "titulo" => "Authorship"
        ]
        10 => array:2 [
          "identificador" => "sec0110"
          "titulo" => "Conflicts of interests"
        ]
        11 => array:2 [
          "identificador" => "xack37812"
          "titulo" => "Acknowledgements"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-01-30"
    "fechaAceptado" => "2011-09-04"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec109315"
          "palabras" => array:6 [
            0 => "White matter"
            1 => "Magnetic resonance"
            2 => "Leukoaraiosis"
            3 => "Multiple sclerosis"
            4 => "CADASIL"
            5 => "Vasculitis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec109316"
          "palabras" => array:6 [
            0 => "Sustancia blanca"
            1 => "Resonancia magn&#233;tica"
            2 => "Leucoaraiosis"
            3 => "Esclerosis m&#250;ltiple"
            4 => "CADASIL"
            5 => "Vasculitis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The presence of hyperintense punctiform images in the white matter in T2-weighted magnetic resonance &#40;MR&#41; sequences is a very common finding and is occasionally a diagnostic challenge for the radiologist&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The present article attempts&#44; using an anatomical approach to the brain circulation&#44; as well as from histopathology correlation studies&#44; to simplify the task of interpreting these images from the description of the three main patterns of hyperintense punctiform images in the white matter&#58; vascular pattern&#44; which corresponds to microvascular lesions&#59; perivascular pattern&#44; which represents inflammatory disease of which the paradigm is multiple sclerosis&#59; and a non-specific pattern&#44; which has to be a microvascular disease&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">From the various semiological elements in the MR images&#44; a predominant pattern can be determined in each case and&#44; in this way&#44; helps in the differential diagnosis&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La presencia de m&#250;ltiples im&#225;genes puntiformes hiperintensas en la sustancia blanca &#40;IPHSB&#41; en las secuencias de resonancia magn&#233;tica &#40;RM&#41; ponderadas en T2 es un hallazgo muy frecuente y&#44; en ocasiones&#44; un reto diagn&#243;stico para el radi&#243;logo&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Este art&#237;culo pretende&#44; a trav&#233;s de una aproximaci&#243;n a la anatom&#237;a de la microcirculaci&#243;n cerebral&#44; as&#237; como a estudios de correlaci&#243;n anatomopatol&#243;gica&#44; simplificar la tarea de interpretaci&#243;n de estas im&#225;genes a partir de la descripci&#243;n de tres principales patrones de presentaci&#243;n de IPHSB&#58; patr&#243;n vascular &#40;PV&#41;&#44; que corresponde a lesiones microvasculares&#44; patr&#243;n perivascular &#40;PpV&#41;&#44; que representa a la enfermedad inflamatoria cuyo paradigma es la esclerosis m&#250;ltiple &#40;EM&#41;&#44; y patr&#243;n inespec&#237;fico &#40;PI&#41;&#44; que suele deberse a enfermedad microvascular&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A partir de varios elementos semiol&#243;gicos en las im&#225;genes de RM se puede determinar un patr&#243;n predominante en cada caso y&#44; de este modo&#44; acotar el diagn&#243;stico diferencial&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Medrano Martorell S&#44; et al&#46; Im&#225;genes puntiformes hiperintensas en la sustancia blanca&#58; una aproximaci&#243;n diagn&#243;stica&#46; Radiolog&#237;a&#46; 2012&#59;54&#58;321&#8211;35&#46;</p>"
      ]
    ]
    "multimedia" => array:21 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1930
            "Ancho" => 2500
            "Tamanyo" => 425967
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cerebral microcirculation&#46; &#40;A&#41; Arterial microcirculation&#46; 1&#58; cortical arteries&#59; 2&#58; pial arteries&#59; 2&#46;1&#58; short branches&#59; 3&#58; subependymal arteries&#59; 4&#58; subependymal perforating arterioles&#59; 5&#58; lenticulostriated and thalamic perforating arterioles&#59; 6&#58; transcerebral arterioles&#46; &#40;B&#41; Venous microcirculation&#46; 1&#58; cortical veins&#59; 2&#58; superficial medullary venules&#59; 3&#58; subependymal venules&#59; 4&#58; deep medullary venules&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1162
            "Ancho" => 1728
            "Tamanyo" => 352586
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Perivascular space&#46; &#40;A&#41; Periarteriolar space of the pial arterioles surrounded by one leptomeningeal layer that separates it from the subpial space &#40;arrow&#41;&#46; Periarteriolar space of lenticulostriated arterioles surrounded by two leptomeningeal layers that separate it from the subpial space &#40;arrowheads in the upper box and asterisks in the lower box&#41;&#59; &#40;B&#41; perivenular space that communicates with the subpial space &#40;arrow&#41;&#59; &#40;C&#41; photomicrographic detail of the perivascular Virchow&#8211;Robin space &#40;arrows&#41; &#40;courtesy of Dr&#46; Susana Boluda&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1313
            "Ancho" => 1400
            "Tamanyo" => 183939
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Perivascular spaces dilated in the corona radiata &#40;A&#41;&#44; the semioval centre &#40;B&#41;&#44; and the mesencephalic region &#40;C&#41;&#46; T1 &#40;shown&#41; and FLAIR sequences demonstrate similar signal to that of the cerebrospinal fluid &#40;D&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1224
            "Ancho" => 950
            "Tamanyo" => 118649
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Five-year old child with headache&#46; Visualization of dilated perivascular spaces is an incidental finding with a dubious or unlikely clinical relevance&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1157
            "Ancho" => 2167
            "Tamanyo" => 257661
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">ARWMC scale &#40;age-related white matter changes&#41; to assess punctate lesions in the white matter using computed tomography and magnetic resonance&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 718
            "Ancho" => 1500
            "Tamanyo" => 216627
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Pathophysiology of the vascular pattern&#46; The picture features the mural and&#47;or endoluminal microvascular lesion that induces the ischemic lesion of the parenchyma&#46; Note the mural hyalinization caused by hypertensive arteriopathy &#40;arrow&#41; and the adjacent ischemic vacuolation &#40;&#42;&#41;&#59; &#40;B&#41; pathophysiology of the perivascular pattern&#46; The picture features a perivascular pathological process and the adjacent parenchymatous lesion&#46; Demyelinating layer caused by perivenular inflammation in a patient with multiple sclerosis&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "fig0035"
        "etiqueta" => "Figure 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
            "Alto" => 1365
            "Ancho" => 2500
            "Tamanyo" => 332187
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Distribution&#46; A mainly supratentorial distribution with frontoparietal prevalence is typical of the vascular pattern&#46; The infratentorial involvement with peripheral distribution suggests a perivascular pattern&#46; The infratentorial involvement with central distribution suggests a vascular pattern&#46;</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "fig0040"
        "etiqueta" => "Figure 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr8.jpeg"
            "Alto" => 1737
            "Ancho" => 2647
            "Tamanyo" => 319499
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Location&#58; &#40;1&#41; juxtacortical&#59; &#40;2&#41; sub-U subcortical&#59; &#40;3&#41; non-bordering deep subcortical&#59; &#40;4&#41; bordering subcortical&#59; &#40;5&#41; periventricular&#44; and &#40;6&#41; corpus callosum&#46; A predominantly juxtacortical involvement or involvement of the corpus callosum is not indicative of a vascular pattern &#40;VP&#41;&#59; the rest of locations favour a VP or a non-specific pattern&#44; and thus&#44; suggest a microvascular cause&#46; Periventricular lesions may be indicative of a VP or a perivascular pattern depending on the shape of the lesion&#46;</p>"
        ]
      ]
      8 => array:7 [
        "identificador" => "fig0045"
        "etiqueta" => "Figure 9"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr9.jpeg"
            "Alto" => 1697
            "Ancho" => 2502
            "Tamanyo" => 248745
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Morphology&#46; Ovoid or fusiform lesions suggest a perivascular pattern&#59; the rest are non-specific&#46;</p>"
        ]
      ]
      9 => array:7 [
        "identificador" => "fig0050"
        "etiqueta" => "Figure 10"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr10.jpeg"
            "Alto" => 2321
            "Ancho" => 1667
            "Tamanyo" => 210190
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Size&#46; Lesions larger than 10&#8211;15<span class="elsevierStyleHsp" style=""></span>mm &#40;not several confluent lesions&#41; suggest a perivascular pattern &#40;inflammation&#44; infection&#41;&#46;</p>"
        ]
      ]
      10 => array:7 [
        "identificador" => "fig0055"
        "etiqueta" => "Figure 11"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr11.jpeg"
            "Alto" => 1459
            "Ancho" => 2083
            "Tamanyo" => 223385
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Enhancement following contrast administration&#46; Absence of enhancement is a non-specific semiological finding&#46; Peripheral incomplete ring-enhancement favours a perivascular pattern caused by multiple sclerosis&#46; Patient with multiple juxtacortical lesions showing typically associated incomplete ring-enhancement&#46;</p>"
        ]
      ]
      11 => array:7 [
        "identificador" => "fig0060"
        "etiqueta" => "Figure 12"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr12.jpeg"
            "Alto" => 994
            "Ancho" => 1600
            "Tamanyo" => 185039
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Residual haemorrhage&#58; &#40;A&#41; cortico-subcortical residual haemorrhage suggests amyloid angiopathy&#59; &#40;B&#41; in the basal ganglia&#44; brainstem&#44; and cerebellum suggests AH&#44; and &#40;C&#41; haemorrhage with a history of trauma suggests diffuse axonal injury&#46;</p>"
        ]
      ]
      12 => array:7 [
        "identificador" => "fig0065"
        "etiqueta" => "Figure 13"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr13.jpeg"
            "Alto" => 1408
            "Ancho" => 750
            "Tamanyo" => 110746
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Grey matter involvement &#40;basal ganglia&#41;&#46; &#40;A&#41; lacunar porencephalic foci&#44; which are likely associated with dilated Virchow&#8211;Robin spaces in a patient with uncontrolled AH&#46; &#40;B&#41; Gelatinous cysts in the Virchow&#8211;Robin spaces of the lenticulostriated vasculature in a 30-year-old patient with AIDS&#44; who firstly presented with cryptococcosis&#46;</p>"
        ]
      ]
      13 => array:7 [
        "identificador" => "fig0070"
        "etiqueta" => "Figure 14"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr14.jpeg"
            "Alto" => 912
            "Ancho" => 1600
            "Tamanyo" => 137518
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Vascular pattern&#58; cerebrovascular risk factors&#46; Patients with AH showing&#58; &#40;A&#41; foci of leukoencephalopathy confluent in the periventricular white matter&#59; &#40;B&#41; involvement of the basal ganglia and the subcortical white matter but no involvement of the subcortical U-fibres&#59; &#40;C&#41; residual haemorrhage in the basal ganglia&#44; brainstem&#44; and cerebellum&#46;</p>"
        ]
      ]
      14 => array:7 [
        "identificador" => "fig0075"
        "etiqueta" => "Figure 15"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr15.jpeg"
            "Alto" => 564
            "Ancho" => 1800
            "Tamanyo" => 151023
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Vascular pattern&#58; amyloid angiopathy&#46; Significant changes of microvascular disease in the fronto-parieto-occipital supratentorial white matter with a vascular pattern &#40;left&#41;&#46; Gradient-echo sequences &#40;centre&#41; show punctate foci of hemosiderin in the cortico-subcortical interface&#44; predominantly posterior &#40;arrow&#41;&#44; suggesting an underlying amyloid angiopathy&#46; On the right&#44; detail of the mural arteriolar deposits of congophilic &#946;-amyloid matter&#46;</p>"
        ]
      ]
      15 => array:7 [
        "identificador" => "fig0080"
        "etiqueta" => "Figure 16"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr16.jpeg"
            "Alto" => 514
            "Ancho" => 1300
            "Tamanyo" => 82790
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Vascular pattern&#58; migraine&#46; In patients with migraine &#40;generally with aura&#41;&#44; it is common to find frontal punctate lesions in the subcortical white matter with no involvement of subcortical U-fibres &#40;arrows&#41;&#46;</p>"
        ]
      ]
      16 => array:7 [
        "identificador" => "fig0085"
        "etiqueta" => "Figure 17"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr17.jpeg"
            "Alto" => 575
            "Ancho" => 1500
            "Tamanyo" => 100739
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Vascular pattern&#58; vasculitis&#46; 63-Year-old woman free of typical cerebrovascular factors with discrete hyperhomocysteinemia and antiphospholipid antibodies&#46; She presented with punctate lesions in the supratentorial white matter with no involvement of the U-fibres &#40;orange arrow&#41; and some areas of a past cortico-subcortical temporoparietal infarct &#40;red arrow&#41;&#46; These findings suggested lupic vasculitis&#46;</p>"
        ]
      ]
      17 => array:7 [
        "identificador" => "fig0090"
        "etiqueta" => "Figure 18"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr18.jpeg"
            "Alto" => 577
            "Ancho" => 1750
            "Tamanyo" => 114152
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Vascular pattern&#58; dominant autosomic cerebral arteriopathy with subcortical infarcts and leukoencephalopathy &#40;CADASIL&#41;&#46; 50-Year-old patient diagnosed with CADASIL with signs of microvascular disease in the supratentorial white matter and involvement of the anterior temporal poles &#40;arrows&#41;&#46;</p>"
        ]
      ]
      18 => array:7 [
        "identificador" => "fig0095"
        "etiqueta" => "Figure 19"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr19.jpeg"
            "Alto" => 711
            "Ancho" => 1800
            "Tamanyo" => 136309
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Perivascular pattern&#58; multiple sclerosis &#40;MS&#41;&#46; &#40;A&#41; juxta-cortical lesions&#59; &#40;B&#41; periventricular lesions in the form of Dawson&#39;s fingers &#40;left and centre&#41;&#46; Confluent lesions with a ridge-like configuration in chronic MS and anterior temporal lesion &#40;right&#41;&#59; &#40;C&#41; callosal-septal lesions&#59; &#40;D&#41; peripheral infratentorial lesions&#59; and &#40;E&#41; peripheral incomplete ring-enhancement&#46;</p>"
        ]
      ]
      19 => array:7 [
        "identificador" => "fig0100"
        "etiqueta" => "Figure 20"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr20.jpeg"
            "Alto" => 1949
            "Ancho" => 2635
            "Tamanyo" => 408629
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Diagnostic algorithm of the hyperintense punctate images in the white matter &#40;HPIWM&#41;&#44; vascular pattern &#40;VP&#41;&#44; perivascular pattern &#40;PvP&#41;&#44; and non-specific pattern &#40;NsP&#41;&#46; ARWMC&#58; ARWMC scale &#40;age-related white matter changes&#41;&#59; CVRFs&#58; cardiovascular risk factors&#59; AH&#58; arterial hypertension&#59; DLP&#58; dyslipidemia&#59; DM&#58; diabetes mellitus&#59; CADASIL&#58; dominant autosomic cerebral arteriopathy with subcortical infarcts and leukoencephalopathy&#59; MS&#58; multiple sclerosis&#46;</p>"
        ]
      ]
      20 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Vascular pattern</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Not juxtacortical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Sub-U subcortical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Deep bordering&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Periventricular irregular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Supra-<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>infratentorial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Supratentorial frontoparietal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Basal ganglia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- No enhancement &#40;if not acute&#41; or mild enhancement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Perivascular pattern</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Periventricular ovoid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Juxtacortical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Fusiform or ovoid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Dawson&#39;s fingers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Supra- and infratentorial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Large lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Non-specific pattern</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Deep non-bordering&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>- Amorphous&#44; punctate&#44; round&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab209449.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Semiological characteristics&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:59 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "From UBOs to Binswanger&#39;s disease&#58; impact of magnetic resonance imaging on vascular dementia research"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46;C&#46; Roman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "1996"
                        "volumen" => "27"
                        "paginaInicial" => "1269"
                        "paginaFinal" => "1273"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8711785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Angiograf&#237;a cerebral"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;G&#46; Osborn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "2nd ed&#46;"
                        "fecha" => "2000"
                        "editorial" => "Marb&#225;n Libros S&#46;L&#46;"
                        "editorialLocalizacion" => "Madrid"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathogenesis of leukoaraiosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Pantoni"
                            1 => "J&#46;H&#46; Garcia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "1997"
                        "volumen" => "28"
                        "paginaInicial" => "652"
                        "paginaFinal" => "659"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9056627"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "MR evaluation of developmental venous anomalies&#58; medullary venous anatomy of venous angiomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Lee"
                            1 => "M&#46;A&#46; Pennington"
                            2 => "C&#46;M&#46; Kenney III"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "1996"
                        "volumen" => "17"
                        "paginaInicial" => "61"
                        "paginaFinal" => "70"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8770251"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Virchow&#8211;Robin spaces at MR imaging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;M&#46; Kwee"
                            1 => "T&#46;C&#46; Kwee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/rg.274065722"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiographics"
                        "fecha" => "2007"
                        "volumen" => "27"
                        "paginaInicial" => "1071"
                        "paginaFinal" => "1086"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17620468"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perivascular spaces in the basal ganglia of the human brain&#58; their relationship to lacunes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Pollock"
                            1 => "M&#46; Hutchings"
                            2 => "R&#46;O&#46; Weller"
                            3 => "E&#46;-T&#46;M&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Anat"
                        "fecha" => "1997"
                        "volumen" => "191"
                        "paginaInicial" => "337"
                        "paginaFinal" => "346"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9418990"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dilated perivascular spaces&#58; hallmarks of mild traumatic brain injury"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Inglese"
                            1 => "E&#46; Bomsztyk"
                            2 => "O&#46; Gonen"
                            3 => "L&#46;J&#46; Mannon"
                            4 => "R&#46;I&#46; Grossman"
                            5 => "H&#46; Rusinek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "719"
                        "paginaFinal" => "724"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15814911"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Large Virchow&#8211;Robin spaces&#58; MR-clinical correlation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;A&#46; Heier"
                            1 => "C&#46;J&#46; Bauer"
                            2 => "L&#46; Schwartz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "1989"
                        "volumen" => "10"
                        "paginaInicial" => "929"
                        "paginaFinal" => "936"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2505536"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Frequency and location of dilated Virchow&#8211;Robin spaces in elderly people&#58; a population-based 3D MR imaging study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46;C&#46; Zhu"
                            1 => "C&#46; Dufouil"
                            2 => "B&#46; Mazoyer"
                            3 => "A&#46; Soumar&#233;"
                            4 => "F&#46; Ricolfi"
                            5 => "C&#46; Tzourio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3174/ajnr.A2366"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "2011"
                        "volumen" => "32"
                        "paginaInicial" => "709"
                        "paginaFinal" => "713"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21349956"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sandlike appearance of Virchow&#8211;Robin spaces in early multiple sclerosis&#58; a novel neuroradiologic marker"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Achiron"
                            1 => "M&#46; Faibel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "2002"
                        "volumen" => "23"
                        "paginaInicial" => "376"
                        "paginaFinal" => "380"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11901003"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46;N&#46; Doubal"
                            1 => "A&#46;M&#46; MacLullich"
                            2 => "K&#46;J&#46; Ferguson"
                            3 => "M&#46;S&#46; Dennis"
                            4 => "J&#46;M&#46; Wardlaw"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/STROKEAHA.109.564914"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2010"
                        "volumen" => "41"
                        "paginaInicial" => "450"
                        "paginaFinal" => "454"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20056930"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dilatation of the Virchow&#8211;Robin space is a sensitive indicator of cerebral microvascular disease&#58; study in elderly patients with dementia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46;F&#46; Patankar"
                            1 => "D&#46; Mitra"
                            2 => "A&#46; Varma"
                            3 => "J&#46; Snowden"
                            4 => "D&#46; Neary"
                            5 => "A&#46; Jackson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "1512"
                        "paginaFinal" => "1520"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15956523"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Virchow&#8211;Robin spaces relate to cerebral small vessel disease severity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46;P&#46; Rouhl"
                            1 => "R&#46;J&#46; van Oostenbrugge"
                            2 => "I&#46;L&#46; Knottnerus"
                            3 => "J&#46;E&#46; Staals"
                            4 => "J&#46; Lodder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00415-008-0777-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurol"
                        "fecha" => "2008"
                        "volumen" => "255"
                        "paginaInicial" => "692"
                        "paginaFinal" => "696"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18286319"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Giant tumefactive perivascular spaces"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;L&#46; Salzman"
                            1 => "A&#46;G&#46; Osborn"
                            2 => "P&#46; House"
                            3 => "J&#46;R&#46; Jinkins"
                            4 => "A&#46; Ditchfield"
                            5 => "J&#46;A&#46; Cooper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "298"
                        "paginaFinal" => "305"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15709127"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Developmental dilatation of Virchow&#8211;Robin spaces&#58; a genetic disorder&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;L&#46; Bruna"
                            1 => "I&#46; Martins"
                            2 => "B&#46; Husson"
                            3 => "P&#46; Landrieu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pediatrneurol.2009.04.026"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Neurol"
                        "fecha" => "2009"
                        "volumen" => "41"
                        "paginaInicial" => "275"
                        "paginaFinal" => "280"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19748047"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age&#44; hypertension&#44; and lacunar stroke are the major determinants of the severity of age-related white matter changes&#46; The LADIS &#40;Leukoaraiosis and Disability in the Elderly&#41; study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;M&#46; Basile"
                            1 => "L&#46; Pantoni"
                            2 => "G&#46; Pracucci"
                            3 => "K&#46; Asplund"
                            4 => "H&#46; Chabriat"
                            5 => "T&#46; Erkinjuntti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000091536"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cerebrovasc Dis"
                        "fecha" => "2006"
                        "volumen" => "21"
                        "paginaInicial" => "315"
                        "paginaFinal" => "322"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16490940"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Demencias e imagen&#58; lo b&#225;sico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; Arana Fern&#225;ndez de Moya"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rx.2009.09.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiolog&#237;a"
                        "fecha" => "2010"
                        "volumen" => "52"
                        "paginaInicial" => "4"
                        "paginaFinal" => "17"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19892380"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The challenge of mixed cerebrovascular disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Fisher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1749-6632.2010.05758.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann N Y Acad Sci"
                        "fecha" => "2010"
                        "volumen" => "1207"
                        "paginaInicial" => "18"
                        "paginaFinal" => "22"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20955421"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Visual rating scales for age-related white matter changes &#40;leukoaraiosis&#41; can the heterogeneity be reduced&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Pantoni"
                            1 => "M&#46; Simoni"
                            2 => "G&#46; Pracucci"
                            3 => "R&#46; Schmidt"
                            4 => "F&#46; Barkhof"
                            5 => "D&#46; Inzitari"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2002"
                        "volumen" => "33"
                        "paginaInicial" => "2827"
                        "paginaFinal" => "2833"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12468777"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "MR signal abnormalities at 1&#46;5<span class="elsevierStyleHsp" style=""></span>T in Alzheimer&#39;s dementia and normal aging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "F&#46; Fazekas"
                            1 => "J&#46;B&#46; Chawluk"
                            2 => "A&#46; Alavi"
                            3 => "H&#46;I&#46; Hurtig"
                            4 => "R&#46;A&#46; Zimmerman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2214/ajr.149.2.351"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJR Am J Roentgenol"
                        "fecha" => "1987"
                        "volumen" => "149"
                        "paginaInicial" => "351"
                        "paginaFinal" => "356"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3496763"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A new ratings scale for age-related white matter changes applicable to MRI and CT"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;O&#46; Wahlund"
                            1 => "F&#46; Barkhof"
                            2 => "F&#46; Fazekas"
                            3 => "L&#46; Bronge"
                            4 => "M&#46; Augustin"
                            5 => "M&#46; Sj&#246;gren"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2001"
                        "volumen" => "32"
                        "paginaInicial" => "1318"
                        "paginaFinal" => "1322"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11387493"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National institute of neurological disorders and stroke-Canadian stroke network vascular cognitive impairment harmonization standards"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Hachinski"
                            1 => "C&#46; Ladecola"
                            2 => "R&#46;C&#46; Petersen"
                            3 => "M&#46;M&#46; Breteler"
                            4 => "D&#46;L&#46; Nyenhuis"
                            5 => "S&#46;E&#46; Black"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.STR.0000237236.88823.47"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2006"
                        "volumen" => "37"
                        "paginaInicial" => "2220"
                        "paginaFinal" => "2241"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16917086"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Barkhof F&#44; Smithuis R&#46; Multiple sclerosis radiology assistant website &#91;publicado 1 Febrer 2007&#59; accessed 15 Ener 2011&#93;&#46; Available from&#58; <a class="elsevierStyleInterRef" href="http://www.radiologyassistant.nl/en/4556dea65db62">http&#58;&#47;&#47;www&#46;radiologyassistant&#46;nl&#47;en&#47;4556dea65db62</a>&#46;"
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathologic correlates of incidental MRI white matter signal hyperintensities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Fazekas"
                            1 => "R&#46; Kleinert"
                            2 => "H&#46; Offenbacher"
                            3 => "R&#46; Schmidt"
                            4 => "G&#46; Kleinert"
                            5 => "F&#46; Payer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurology"
                        "fecha" => "1993"
                        "volumen" => "43"
                        "paginaInicial" => "1683"
                        "paginaFinal" => "1689"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8414012"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Understanding white matter disease&#46; Imaging-pathological correlations in vascular cognitive impairment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Black"
                            1 => "F&#46; Gao"
                            2 => "J&#46; Bilbao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/STROKEAHA.108.537704"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2009"
                        "volumen" => "40"
                        "paginaInicial" => "S48"
                        "paginaFinal" => "S52"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19064767"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neuropathology of cerebrovascular diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;N&#46; Hazrati"
                            1 => "C&#46; Bergeron"
                            2 => "J&#46; Butany"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Diagn Pathol"
                        "fecha" => "2009"
                        "volumen" => "26"
                        "paginaInicial" => "103"
                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19891304"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neuropathologic correlates of white matter hyperintensities"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46;G&#46; Young"
                            1 => "G&#46;M&#46; Halliday"
                            2 => "J&#46;J&#46; Kril"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1212/01.wnl.0000319691.50117.54"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurology"
                        "fecha" => "2008"
                        "volumen" => "71"
                        "paginaInicial" => "804"
                        "paginaFinal" => "811"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18685136"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age-related changes in normal-appearing brain tissue and white matter hyperintensities&#58; more of the same or something else&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Spilt"
                            1 => "T&#46; Geeraedts"
                            2 => "A&#46;J&#46; de Craen"
                            3 => "R&#46;G&#46; Westendorp"
                            4 => "G&#46;J&#46; Blauw"
                            5 => "M&#46;A&#46; van Buchem"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "725"
                        "paginaFinal" => "729"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15814912"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Not all age-related white matter hyperintensities are the same&#58; a magnetization transfer imaging study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Spilt"
                            1 => "R&#46; Goekoop"
                            2 => "R&#46;G&#46; Westendorp"
                            3 => "G&#46;J&#46; Blauw"
                            4 => "A&#46;J&#46; de Craen"
                            5 => "M&#46;A&#46; van Buchem"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "2006"
                        "volumen" => "27"
                        "paginaInicial" => "1964"
                        "paginaFinal" => "1968"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17032876"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Magnetization transfer ratio of white matter hyperintensities in subcortical ischemic vascular dementia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Tanabe"
                            1 => "F&#46; Ezekiel"
                            2 => "W&#46;J&#46; Jagust"
                            3 => "B&#46;R&#46; Reed"
                            4 => "D&#46; Norman"
                            5 => "N&#46; Schuff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "1999"
                        "volumen" => "20"
                        "paginaInicial" => "839"
                        "paginaFinal" => "844"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10369354"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging of white matter lesions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46; Barkhof"
                            1 => "P&#46; Scheltens"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cerebrovasc Dis"
                        "fecha" => "2002"
                        "volumen" => "13"
                        "paginaInicial" => "S21"
                        "paginaFinal" => "S30"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prominent perivenular spaces in multiple sclerosis as a sign of perivascular inflammation in primary demyelination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46; Ge"
                            1 => "M&#46; Law"
                            2 => "J&#46; Herbert"
                            3 => "R&#46;I&#46; Grossman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "2316"
                        "paginaFinal" => "2319"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16219839"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The clinical importance of white matter hyperintensities on brain magnetic resonance imaging&#58; systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Debette"
                            1 => "H&#46;S&#46; Markus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2010"
                        "volumen" => "26"
                        "paginaInicial" => "c3666"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Rovira A&#46; Multiple sclerosis and other idiopathic inflamatory-demyelinating diseases of the central nervous system&#46; Programa de formaci&#243;n continuada en radiodiagn&#243;stico&#46; Curso espec&#237;fico 2006&#8211;2009&#46; Neurorradiolog&#237;a&#46; Website de radi&#242;legs de Catalunya &#91;publicado en 2009&#59; accessed 9 Juli 2011&#93;&#46; Available from&#58; <a class="elsevierStyleInterRef" href="http://www.radiolegsdecatalunya.cat/formacio/resums/GE85EN08_R.pdf">http&#58;&#47;&#47;www&#46;radiolegsdecatalunya&#46;cat&#47;formacio&#47;resums&#47;GE85EN08&#95;R&#46;pdf</a>&#46;"
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Headache&#44; migraine&#44; and structural brain lesions and function&#58; population base epidemiology of vascular ageing-MRI study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Kurth"
                            1 => "S&#46; Mohamed"
                            2 => "P&#46; Maillard"
                            3 => "Y&#46; Zhu"
                            4 => "H&#46; Chabriat"
                            5 => "B&#46; Mazoyer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2011"
                        "volumen" => "342"
                        "paginaInicial" => "c7357"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21245119"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic inflammatory-demyelinating diseases of the central nervous system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;R&#46; Ca&#241;ellas"
                            1 => "A&#46;R&#46; Gols"
                            2 => "J&#46;R&#46; Izquierdo"
                            3 => "M&#46;T&#46; Subirana"
                            4 => "X&#46;M&#46; Gairin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00234-007-0216-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neuroradiology"
                        "fecha" => "2007"
                        "volumen" => "49"
                        "paginaInicial" => "393"
                        "paginaFinal" => "409"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17333161"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Case 142&#58; Susac syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;K&#46; Demir"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiol.2502051865"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2009"
                        "volumen" => "250"
                        "paginaInicial" => "598"
                        "paginaFinal" => "602"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19188329"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Distribution of cranial MRI abnormalities in patients with symptomatic and subclinical CADASIL"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Coulthard"
                            1 => "S&#46;C&#46; Blank"
                            2 => "K&#46; Bushby"
                            3 => "R&#46;N&#46; Kalaria"
                            4 => "D&#46;J&#46; Burn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1259/bjr.73.867.10817040"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Radiol"
                        "fecha" => "2000"
                        "volumen" => "73"
                        "paginaInicial" => "256"
                        "paginaFinal" => "265"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10817040"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multiple sclerosis&#58; the history of the disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46;J&#46; Murray"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2005"
                        "editorial" => "Demos Medical Publishing LLC"
                        "editorialLocalizacion" => "New York"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extent and distribution of white matter hyperintensities in stroke patients&#58; the Sydney stroke study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46; Wen"
                            1 => "P&#46;S&#46; Sachdev"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/01.STR.0000147034.25760.3d"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2004"
                        "volumen" => "35"
                        "paginaInicial" => "2813"
                        "paginaFinal" => "2819"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15499036"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Enfermedad cerebrovascular&#46; Ictus isqu&#233;mico&#46; Ictus hemorr&#225;gico&#46; Aneurismas y malformaciones vasculares"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Munuera"
                            1 => "A&#46; Rovira"
                            2 => "J&#46;L&#46; Caniego"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "Radiolog&#237;a esencial&#46; Tomo 2"
                        "paginaInicial" => "1093"
                        "paginaFinal" => "1106"
                        "edicion" => "1st ed&#46;"
                        "serieFecha" => "2009"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "MRI criteria for MS in patients with clinically isolated syndromes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "X&#46; Montalban"
                            1 => "M&#46; Tintor&#233;"
                            2 => "J&#46; Swanton"
                            3 => "F&#46; Barkhof"
                            4 => "F&#46; Fazekas"
                            5 => "M&#46; Filippi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1212/WNL.0b013e3181cec45c"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurology"
                        "fecha" => "2010"
                        "volumen" => "74"
                        "paginaInicial" => "427"
                        "paginaFinal" => "434"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20054006"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and risk factors of cerebral microbleeds&#58; an update of the Rotterdam scan study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;M&#46; Poels"
                            1 => "M&#46;W&#46; Vernooij"
                            2 => "M&#46;A&#46; Ikram"
                            3 => "A&#46; Hofman"
                            4 => "G&#46;P&#46; Krestin"
                            5 => "A&#46; van der Lugt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/STROKEAHA.110.607184"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2010"
                        "volumen" => "42"
                        "paginaInicial" => "656"
                        "paginaFinal" => "661"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21307170"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Angiitis of the central nervous system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Zuber"
                            1 => "J&#46; Blustajn"
                            2 => "S&#46; Arquizan"
                            3 => "D&#46; Trystam"
                            4 => "J&#46;L&#46; Mas"
                            5 => "J&#46;F&#46; Meder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neuroradiol"
                        "fecha" => "1999"
                        "volumen" => "26"
                        "paginaInicial" => "101"
                        "paginaFinal" => "117"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10444934"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diffuse axonal injury associated with chronic traumatic brain injury&#58; evidence from T2&#42;-weighted gradient-echo imaging at 3<span class="elsevierStyleHsp" style=""></span>T"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Scheid"
                            1 => "C&#46; Preul"
                            2 => "O&#46; Gruber"
                            3 => "C&#46; Wiggind"
                            4 => "D&#46;Y&#46; von Cramon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "2003"
                        "volumen" => "24"
                        "paginaInicial" => "1049"
                        "paginaFinal" => "1056"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12812926"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Acute disseminated encephalomyelitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Politi"
                            1 => "P&#46; Papanagiotou"
                            2 => "I&#46;Q&#46; Grunwald"
                            3 => "C&#46; Roth"
                            4 => "W&#46; Reith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00117-008-1693-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiologe"
                        "fecha" => "2008"
                        "volumen" => "48"
                        "paginaInicial" => "553"
                        "paginaFinal" => "559"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18478196"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correlation of MR imaging findings and clinical manifestations in neurosarcoidosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Shah"
                            1 => "G&#46;H&#46; Roberson"
                            2 => "J&#46;K&#46; Cur&#233;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3174/ajnr.A1470"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "2009"
                        "volumen" => "30"
                        "paginaInicial" => "953"
                        "paginaFinal" => "961"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19193748"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "MR of CNS sarcoidosis&#58; correlation of imaging features to clinical symptoms and response to treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46;A&#46; Christoforidis"
                            1 => "E&#46;M&#46; Spickler"
                            2 => "M&#46;V&#46; Recio"
                            3 => "B&#46;M&#46; Mehta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "1999"
                        "volumen" => "20"
                        "paginaInicial" => "655"
                        "paginaFinal" => "669"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10319978"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Magnetic resonance imaging findings in AIDS patients with central nervous system cryptococcosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Corti"
                            1 => "M&#46;F&#46; Villafa&#241;e"
                            2 => "R&#46; Negroni"
                            3 => "A&#46; Arechavala"
                            4 => "E&#46; Maiolo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Iberoam Micol"
                        "fecha" => "2008"
                        "volumen" => "25"
                        "paginaInicial" => "211"
                        "paginaFinal" => "214"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19071888"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cerebral vasculitis&#58; MR imaging and angiographic correlation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;J&#46; Greenan"
                            1 => "R&#46;I&#46; Grossman"
                            2 => "H&#46;I&#46; Goldberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiology.182.1.1727311"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "1992"
                        "volumen" => "182"
                        "paginaInicial" => "65"
                        "paginaFinal" => "72"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1727311"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cerebral amyloid angiopathy&#58; CT and MR imaging findings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;P&#46; Chao"
                            1 => "A&#46;L&#46; Kotsenas"
                            2 => "D&#46;F&#46; Broderick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/rg.265055090"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiographics"
                        "fecha" => "2006"
                        "volumen" => "26"
                        "paginaInicial" => "1517"
                        "paginaFinal" => "1531"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16973779"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "MRI in migraineurs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Robbins"
                            1 => "H&#46; Friedman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Headache"
                        "fecha" => "1992"
                        "volumen" => "32"
                        "paginaInicial" => "507"
                        "paginaFinal" => "508"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1468910"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging findings of migraine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46;M&#46; Cutrer"
                            1 => "D&#46;F&#46; Black"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1526-4610.2006.00503.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Headache"
                        "fecha" => "2006"
                        "volumen" => "46"
                        "paginaInicial" => "1095"
                        "paginaFinal" => "1107"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16866714"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infarcts in the posterior circulation territory in migraine&#46; The population-based MRI CAMERA study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;C&#46; Kruit"
                            1 => "L&#46;J&#46; Launer"
                            2 => "M&#46;D&#46; Ferrari"
                            3 => "M&#46;A&#46; van Buchem"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/brain/awh542"
                      "Revista" => array:6 [
                        "tituloSerie" => "Brain"
                        "fecha" => "2005"
                        "volumen" => "128"
                        "paginaInicial" => "2068"
                        "paginaFinal" => "2077"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16006538"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Arteriopat&#237;a cerebral autos&#243;mica dominante con infartos subcorticales y leucoencefalopat&#237;a &#40;CADASIL&#41;&#46; Una revisi&#243;n"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Navarro"
                            1 => "F&#46; D&#237;az"
                            2 => "L&#46; Mu&#241;oz"
                            3 => "S&#46; Jim&#233;nez-Rold&#225;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurolog&#237;a"
                        "fecha" => "2002"
                        "volumen" => "17"
                        "paginaInicial" => "410"
                        "paginaFinal" => "417"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12396971"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The spatial distribution of MR imaging abnormalities in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and their relationship to age and clinical features"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Singhal"
                            1 => "P&#46; Rich"
                            2 => "H&#46;S&#46; Markus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "2005"
                        "volumen" => "26"
                        "paginaInicial" => "2481"
                        "paginaFinal" => "2487"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16286388"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Differential lesion patterns in CADASIL and sporadic subcortical arteriosclerotic encephalopathy&#58; MR imaging study with statistical parametric group comparison"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;P&#46; Auer"
                            1 => "B&#46; P&#252;tz"
                            2 => "C&#46; G&#246;ssl"
                            3 => "G&#46; Elbel"
                            4 => "T&#46; Gasser"
                            5 => "M&#46; Dichgans"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiology.218.2.r01fe24443"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2001"
                        "volumen" => "218"
                        "paginaInicial" => "443"
                        "paginaFinal" => "451"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11161160"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lyme neuroborreliosis&#58; manifestations of a rapidly emerging zoonosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Hildenbrand"
                            1 => "D&#46;E&#46; Craven"
                            2 => "R&#46; Jones"
                            3 => "P&#46; Nemeskal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3174/ajnr.A1579"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "2009"
                        "volumen" => "30"
                        "paginaInicial" => "1079"
                        "paginaFinal" => "1087"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19346313"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The spectrum of nervous system involvement in Beh&#231;et&#39;s syndrome and its differential diagnosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Siva"
                            1 => "S&#46; Saip"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00415-009-0145-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurol"
                        "fecha" => "2009"
                        "volumen" => "256"
                        "paginaInicial" => "513"
                        "paginaFinal" => "529"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19444529"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:3 [
        "identificador" => "xack37812"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0325" class="elsevierStylePara elsevierViewall">We would like to thank Susana Boluda&#44; neuropathologist at the Unit of Neuropathology of Bellvitge Hospital&#44; for providing the microphotographs of pathological correlation&#59; Dolores Cocho&#44; neurologist at the Unit of Neurology of Granollers Hospital&#44; for providing the databases of representative cases&#59; and illustrator Txomin Medrano for the anatomy illustrations&#46;</p>"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735107/0000005400000004/v1_201305061502/S2173510712001000/v1_201305061502/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "8097"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Updates in radiology"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735107/0000005400000004/v1_201305061502/S2173510712001000/v1_201305061502/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510712001000?idApp=UINPBA00004N"
]

Article information

ISSN: 21735107
Original language: English

DOI:10.1016/j.rxeng.2011.09.001

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	0	167	167
2024 September	0	303	303
2024 August	0	306	306
2024 July	0	417	417
2024 June	0	362	362
2024 May	0	339	339
2024 April	0	372	372
2024 March	0	384	384
2024 February	0	321	321
2024 January	0	279	279
2023 December	0	286	286
2023 November	0	238	238
2023 October	0	165	165
2023 September	0	79	79
2023 August	0	84	84
2023 July	0	107	107
2023 June	0	85	85
2023 May	0	90	90
2023 April	0	90	90
2023 March	2	154	156
2023 February	0	60	60
2023 January	0	57	57
2022 December	0	59	59
2022 November	0	58	58
2022 October	0	46	46
2022 September	0	51	51
2022 August	0	60	60
2022 July	0	37	37
2022 June	0	62	62
2022 May	0	82	82
2022 April	0	95	95
2022 March	0	82	82
2022 February	0	60	60
2022 January	0	68	68
2021 December	0	77	77
2021 November	0	53	53
2021 October	0	101	101
2021 September	0	99	99
2021 August	0	53	53
2021 July	0	41	41
2021 June	0	34	34
2021 May	0	49	49
2021 April	0	107	107
2021 March	0	78	78
2021 February	0	43	43
2021 January	1	40	41
2020 December	0	49	49
2020 November	0	40	40
2020 October	0	38	38
2020 September	0	37	37
2020 August	0	33	33
2020 July	0	19	19
2020 June	0	28	28
2020 May	0	33	33
2020 April	0	22	22
2020 March	0	49	49
2020 February	0	59	59
2020 January	0	50	50
2019 December	0	11	11
2019 November	0	38	38
2019 October	0	28	28
2019 September	0	38	38
2019 August	0	22	22
2019 July	0	55	55
2019 June	0	34	34
2019 May	0	45	45
2019 April	0	29	29
2019 March	0	5	5
2019 February	0	5	5
2018 August	0	3	3
2018 May	60	1	61
2018 April	523	33	556
2018 March	490	23	513
2018 February	404	12	416
2018 January	532	20	552
2017 December	425	19	444
2017 November	437	30	467
2017 October	406	21	427
2017 September	419	33	452
2017 August	506	28	534
2017 July	434	29	463
2017 June	448	75	523
2017 May	485	69	554
2017 April	375	36	411
2017 March	468	61	529
2017 February	397	41	438
2017 January	287	16	303
2016 December	301	29	330
2016 November	407	40	447
2016 October	391	35	426
2016 September	448	34	482
2016 August	253	32	285
2016 July	299	14	313
2016 June	385	69	454
2016 May	444	86	530
2016 April	342	77	419
2016 March	380	65	445
2016 February	284	83	367
2016 January	283	68	351
2015 December	294	69	363
2015 November	328	73	401
2015 October	412	104	516
2015 September	329	67	396
2015 August	365	48	413
2015 July	458	56	514
2015 June	354	54	408
2015 May	400	72	472
2015 April	456	61	517
2015 March	577	51	628
2015 February	262	19	281
2015 January	64	17	81
2014 December	99	21	120
2014 November	68	13	81
2014 October	111	25	136
2014 September	87	11	98
2014 August	82	14	96
2014 July	95	21	116
2014 June	74	11	85
2014 May	66	10	76
2014 April	84	14	98
2014 March	734	65	799
2014 February	796	58	854
2014 January	851	48	899
2013 December	714	54	768
2013 November	815	41	856
2013 October	831	49	880
2013 September	711	49	760
2013 August	694	69	763
2013 July	567	53	620
2013 June	439	59	498
2013 May	418	44	462
2013 April	278	42	320
2013 March	192	36	228
2013 February	170	20	190
2013 January	198	14	212
2012 December	24	7	31
2012 November	7	8	15

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter