In vivo Detection of Cortical Microinfarcts on Ultrahigh‐Field MRI

Yuichiro,; Maeda, Masayuki; Kida, Hirotaka; Matsuo, Kimiko; Shindo, Akihiro; Taniguchi, Akira; Tomimoto, Hidekazu

doi:10.1111/j.1552-6569.2012.00722.x

Cited by 62 publications

(42 citation statements)

References 40 publications

(110 reference statements)

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“…10,11 Nevertheless, recent literature has shown that 3.0 T MRI is also able to visualize these ultra-small lesion. 9 However, in this study, only cognitive impaired patients were analyzed and the smallest CMIs were still not visible. In literature, a certain range of definitions of CMIs is used, deferring from invisible with the naked eye to o 5 mm.…”

Section: Discussionmentioning

confidence: 87%

7.0 T MRI Detection of Cerebral Microinfarcts in Patients with a Symptomatic High-Grade Carotid artery Stenosis

Rotte

Köning

Hartog

et al. 2014

J Cereb Blood Flow Metab

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In the current study, the presence of cerebral cortical microinfarcts (CMIs) was evaluated in a series of 21 patients with a symptomatic high-grade 450% stenosis of the carotid artery. A T 2 -weighted fluid-attenuated inversion recovery sequence and a T 1 -weighted turbo field echo sequence of the brain were obtained at 7.0 Tesla magnetic resonance imaging. Primary study endpoint was the number of CMIs and macroinfarcts. In total, 53 cerebral infarcts (35 macroinfarcts; 18 CMIs) were found ipsilateral to the symptomatic carotid artery, in 14 patients (67%). In four of these patients, both CMIs and macroinfarcts were visible. In the contralateral hemisphere, seven infarcts (five macroinfarcts and two CMIs) were found in five patients (24%). In the ipsilateral hemispheres, the number of CMIs and macroinfarcts were significantly correlated (P = 0.02). Unpaired comparison of medians showed that the number of CMIs in the ipsilateral hemisphere was significantly higher than the number of CMIs in the contralateral hemisphere (P = 0.04). No significant correlation was found between stenosis grade and the number of any infarct. The current study shows that in symptomatic patients with significant extracranial carotid artery stenosis, CMIs are part of the total cerebrovascular burden and these CMIs prevail with a similar pattern as observed macroinfarcts.

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Section: Discussionmentioning

confidence: 87%

7.0 T MRI Detection of Cerebral Microinfarcts in Patients with a Symptomatic High-Grade Carotid artery Stenosis

Rotte

Köning

Hartog

et al. 2014

J Cereb Blood Flow Metab

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“…6 The diameter of CMIs detected in our study was ≥ 1 mm, indicating that only the larger CMIs can be detected on 3.0T MRI. 3,5,23 Hence, the actual burden of CMIs in patients with stroke/ TIA is likely to be much greater than what can be appreciated on MRI.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Cognitive Relevance of Cortical Cerebral Microinfarcts in Patients With Ischemic Stroke or Transient Ischemic Attack

Wang

Veluw

Wong

et al. 2016

Stroke

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Background and Purpose— It was recently demonstrated that cerebral microinfarcts (CMIs) can be detected in vivo using 3.0 tesla (T) magnetic resonance imaging. We investigated the prevalence, risk factors, and the longitudinal cognitive consequence of cortical CMIs on 3.0T magnetic resonance imaging, in patients with ischemic stroke or transient ischemic attack. Methods— A total of 231 patients undergoing 3.0T magnetic resonance imaging were included. Montreal Cognitive Assessment was used to evaluate global cognitive functions and cognitive domains (memory, language, and attention visuospatial and executive functions). Cognitive changes were represented by the difference in Montreal Cognitive Assessment score between baseline and 28-month after stroke/transient ischemic attack. The cross-sectional and longitudinal associations between cortical CMIs and cognitive functions were explored using ANCOVA and regression models. Results— Cortical CMIs were observed in 34 patients (14.7%), including 13 patients with acute (hyperintense on diffusion-weighted imaging) and 21 with chronic CMIs (isointense on diffusion-weighted imaging). Atrial fibrillation was a risk factor for all cortical CMIs (odds ratio, 4.8; 95% confidence interval, 1.5–14.9; P =0.007). Confluent white matter hyperintensities was associated with chronic CMIs (odds ratio, 2.8; 95% confidence interval, 1.0–7.8; P =0.047). The presence of cortical CMIs at baseline was associated with worse visuospatial functions at baseline and decline over 28-month follow-up (β=0.5; 95% confidence interval, 0.1–1.0; P =0.008, adjusting for brain atrophy, white matter hyperintensities, lacunes, and microbleeds). Conclusions— Cortical CMIs are a common finding in patients with stroke/transient ischemic attack. Associations between CMI with atrial fibrillation and white matter hyperintensities suggest that these lesions have a heterogeneous cause, involving microembolism and cerebral small vessel disease. CMI seemed to preferentially impact visuospatial functions as assessed by a cognitive screening test.

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“…Despite lower signal-to-noise ratio and resolution, it seems feasible to recognize chronic gliotic CMIs on 3-tesla MRI as well. 5,[26][27][28] Hemorrhagic CMIs cannot currently be distinguished from primary hemorrhages, both will be regarded as cerebral microbleeds on in vivo MRI. Juxtacortical hyperintense lesions should best be discarded.…”

Section: Discussionmentioning

confidence: 99%

The Spectrum of MR Detectable Cortical Microinfarcts: A Classification Study with 7-Tesla Postmortem MRI and Histopathology

Veluw

Zwanenburg

Rozemüller

et al. 2015

J Cereb Blood Flow Metab

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Cerebral microinfarcts (CMIs) are common neuropathologic findings in aging and dementia. We explored the spectrum of cortical CMIs that can be visualized with 7T magnetic resonance imaging (MRI). Thirty-three coronal brain slices of 11 individuals with neuropathologically confirmed dementia were subjected to a high-resolution postmortem 7T MRI protocol. First, we identified all visible small (⩽5 mm) intracortical and juxtacortical lesions on postmortem MRI. Lesions were classified as CMI or nonCMI based on histology, and their MR features were recorded. Thirty lesions were identified on the initial MRI evaluation, of which twenty-three could be matched with histology. Histopathology classified 12 lesions as CMIs, all of which were located intracortically. On the basis of their MR features, they could be classified as chronic gliotic CMIs-with or without cavitation or hemorrhagic components-and acute CMIs. Eleven MRI identified lesions were not of ischemic nature and most commonly enlarged or atypically shaped perivascular spaces. Their MRI features were similar to gliotic CMIs with or without cavitation, but these 'CMI mimics' were always located juxtacortically. 7T postmortem MRI distinguishes different histopathologic types of cortical CMIs, with distinctive MR characteristics. On the basis of our findings, we propose in vivo rating criteria for the detection of intracortical CMIs.

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In vivo Detection of Cortical Microinfarcts on Ultrahigh‐Field MRI

Abstract: DIR and 3D-FLAIR images may open a way to visualize CMIs.

Cited by 62 publications

References 40 publications

7.0 T MRI Detection of Cerebral Microinfarcts in Patients with a Symptomatic High-Grade Carotid artery Stenosis

7.0 T MRI Detection of Cerebral Microinfarcts in Patients with a Symptomatic High-Grade Carotid artery Stenosis

Risk Factors and Cognitive Relevance of Cortical Cerebral Microinfarcts in Patients With Ischemic Stroke or Transient Ischemic Attack

The Spectrum of MR Detectable Cortical Microinfarcts: A Classification Study with 7-Tesla Postmortem MRI and Histopathology

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