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- Title
Contribution of acute infarcts to cerebral small vessel disease progression.
- Authors
Telgte, Annemieke; Wiegertjes, Kim; Gesierich, Benno; Marques, José P.; Huebner, Mathias; Klerk, Jabke J.; Schreuder, Floris H. B. M.; Araque Caballero, Miguel A.; Kuijf, Hugo J.; Norris, David G.; Klijn, Catharina J. M.; Dichgans, Martin; Tuladhar, Anil M.; Duering, Marco; Leeuw, Frank‐Erik; Ter Telgte, Annemieke; de Klerk, Jabke J; de Leeuw, Frank-Erik
- Abstract
<bold>Objective: </bold>To determine the contribution of acute infarcts, evidenced by diffusion-weighted imaging positive (DWI+) lesions, to progression of white matter hyperintensities (WMH) and other cerebral small vessel disease (SVD) markers.<bold>Methods: </bold>We performed monthly 3T magnetic resonance imaging (MRI) for 10 consecutive months in 54 elderly individuals with SVD. MRI included high-resolution multishell DWI, and 3-dimensional fluid-attenuated inversion recovery, T1, and susceptibility-weighted imaging. We determined DWI+ lesion evolution, WMH progression rate (ml/mo), and number of incident lacunes and microbleeds, and calculated for each marker the proportion of progression explained by DWI+ lesions.<bold>Results: </bold>We identified 39 DWI+ lesions on 21 of 472 DWI scans in 9 of 54 subjects. Of the 36 DWI+ lesions with follow-up MRI, 2 evolved into WMH, 4 evolved into a lacune (3 with cavity <3mm), 3 evolved into a microbleed, and 27 were not detectable on follow-up. WMH volume increased at a median rate of 0.027 ml/mo (interquartile range = 0.005-0.073), but was not significantly higher in subjects with DWI+ lesions compared to those without (p = 0.195). Of the 2 DWI+ lesions evolving into WMH on follow-up, one explained 23% of the total WMH volume increase in one subject, whereas the WMH regressed in the other subject. DWI+ lesions preceded 4 of 5 incident lacunes and 3 of 10 incident microbleeds.<bold>Interpretation: </bold>DWI+ lesions explain only a small proportion of the total WMH progression. Hence, WMH progression seems to be mostly driven by factors other than acute infarcts. DWI+ lesions explain the majority of incident lacunes and small cavities, and almost one-third of incident microbleeds, confirming that WMH, lacunes, and microbleeds, although heterogeneous on MRI, can have a common initial appearance on MRI. ANN NEUROL 2019;86:582-592.
- Subjects
CEREBRAL small vessel diseases; DISEASE progression; DIFFUSION magnetic resonance imaging; MAGNETIC resonance imaging; BRAIN; CEREBRAL hemorrhage; COMPARATIVE studies; INFARCTION; RESEARCH methodology; MEDICAL cooperation; NEURORADIOLOGY; RESEARCH; EVALUATION research; DISEASE incidence; LACUNAR stroke; DISEASE complications
- Publication
Annals of Neurology, 2019, Vol 86, Issue 4, p582
- ISSN
0364-5134
- Publication type
journal article
- DOI
10.1002/ana.25556