Pathologic correlates of incidental MRI white matter signal hyperintensities

Abstract

We related the histopathologic changes associated with incidental white matter signal hyperintensities on MRIs from 11 elderly patients (age range, 52 to 82 years) to a descriptive classification for such abnormalities. Punctate, early confluent, and confluent white matter hyperintensities corresponded to increasing severity of ischemic tissue damage, ranging from mild perivascular alterations to large areas with variable loss of fibers, multiple small cavitations, and marked arteriolosclerosis. Microcystic infarcts and patchy rarefaction of myelin were also characteristic for irregular periventricular high signal intensity. Hyperintense periventricular caps and a smooth halo, however, were of nonischemic origin and constituted areas of demyelination associated with subependymal gliosis and discontinuity of the ependymal lining. Based on these findings, our classification appears to reflect both the different etiologies and severities of incidental MRI signal abnormalities, if it is modified to treat irregular periventricular and confluent deep white matter hyperintensities together.

Cognitive dysfunction associates with white matter hyperintensities and subcortical atrophy on magnetic resonance imaging of the elderly diabetes mellitus Japanese elderly diabetes intervention trial (J‐EDIT)

“…Subcortical WMHs on T2-weighted MR imaging correlate with several pathological changes such as myelin pallor, dilatation of the perivascular space, myelin or axonal loss, scattered cystic infarcts and angionecrosis. Periventricular hyperintensities on MR scans are associated with partial breakdown of the ependymal cell lining and subependymal gliosis in addition to the pathological changes of subcortical WMHs [43,44]. Although characteristic pathological features of the diabetic brain have yet not been identified, vascular compromise is common in the elderly and is accompanied by damage to white matter pathways [12,45].…”

Silent brain infarct is independently associated with arterial stiffness indicated by cardio-ankle vascular index (CAVI)

“…[5][6][7]14 WMHs were defined as an irregular periventricular hyperintensity (Fazekas grade X3) and/ or early confluent or confluent separate deep white-matter hyperintense lesions (Fazekas grade X2) on T2WI and FLAIR, based on the rating scales of ischemic tissue damage due to arteriosclerosis. 5,7,14,31,32 Carotid ultrasonography Far wall common carotid artery intima-media thickness (CCAIMT) was measured using images acquired by high-resolution B-mode ultrasonography with a 7.5-MHz linear array transducer. 14 Three determinations of intima-media thickness were performed at the thickest point: maximum CCAIMT and two adjacent points (1 cm upstream and 1 cm downstream from this site).…”

Genetic factors in cerebral small vessel disease and their impact on stroke and dementia

“…4 Among the most commonly used markers are radiologic white matter hyperintensities (WMH) and lacunar infarcts. They can both be quantified thus offering greater statistical power than binary phenotypes such as stroke or dementia.…”