Neurologic/Head and Neck Imaging

Cytotoxic Lesions of the Corpus Callosum That Show Restricted Diffusion: Mechanisms, Causes, and Manifestations

Published Online:Feb 6 2017https://doi.org/10.1148/rg.2017160085

Abstract

This article describes the imaging spectrum and the causes of cytotoxic lesions of the corpus callosum.

Cytotoxic lesions of the corpus callosum (CLOCCs) are secondary lesions associated with various entities. CLOCCs have been found in association with drug therapy, malignancy, infection, subarachnoid hemorrhage, metabolic disorders, trauma, and other entities. In all of these conditions, cell-cytokine interactions lead to markedly increased levels of cytokines and extracellular glutamate. Ultimately, this cascade can lead to dysfunction of the callosal neurons and microglia. Cytotoxic edema develops as water becomes trapped in these cells. On diffusion-weighted magnetic resonance (MR) images, CLOCCs manifest as areas of low diffusion. CLOCCs lack enhancement on contrast material–enhanced images, tend to be midline, and are relatively symmetric. The involvement of the corpus callosum typically shows one of three patterns: (a) a small round or oval lesion located in the center of the splenium, (b) a lesion centered in the splenium but extending through the callosal fibers laterally into the adjacent white matter, or (c) a lesion centered posteriorly but extending into the anterior corpus callosum. CLOCCs are frequently but not invariably reversible. Their pathologic mechanisms are discussed, the typical MR imaging findings are described, and typical cases of CLOCCs are presented. Although CLOCCs are nonspecific with regard to the underlying cause, additional imaging findings and the clinical findings can aid in making a specific diagnosis. Radiologists should be familiar with the imaging appearance of CLOCCs to avoid a misdiagnosis of ischemia. When CLOCCs are found, the underlying cause of the lesion should be sought and addressed.

^©RSNA, 2017

An earlier incorrect version of this article appeared online. This article was corrected on February 13, 2017.

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Article History

Received: Apr 3 2016
Revision requested: Sept 1 2016
Revision received: Sept 22 2016
Accepted: Nov 1 2016
Published online: Feb 06 2017
Published in print: Mar 2017

Vol. 37, No. 2

Abbreviations

Abbreviations:
ADC	apparent diffusion coefficient
CLOCC	cytotoxic lesion of the corpus callosum
CNS	central nervous system
EBV	Epstein-Barr virus
FLAIR	fluid-attenuated inversion-recovery
H-E	hematoxylin-eosin
IL	interleukin
SAH	subarachnoid hemorrhage
TNF-α	tumor necrosis factor-α

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