Wide Variation in Definition, Detection, and Description of Lacunar Lesions on Imaging

Abstract

Background and Purpose-Variation in the definition of lacunar lesions on imaging and difficulties in their detection may be hampering lacunar stroke research. We assessed literature definitions of imaging lacunar lesions and the definitions and detection of lacunar lesions among small-vessel disease researchers. Methods-We assessed definitions of imaging lacunar lesion in 50 randomly selected articles from 3 stroke-related journals and an online survey of small-vessel disease researchers. In the literature review, we assessed clinical/imaging definitions of lacunar stroke. In the survey, we assessed lacunar lesion detection, effects of lesion appearance, background white matter lesions, and provision of relevant data. Results-Among 50 articles, imaging definitions were varied and often limited; size was stated in 21 of 43 (49%) studies of acute and in 9 of 20 (45%) studies of old lesions and site in 18 (42%) and 4 (20%), respectively. Clinical definitions also varied, and images were read mostly by nonradiologists. Among 56 survey respondents, multiple descriptions were used for recent and old, symptomatic and asymptomatic, lesions on imaging. Most agreed on definitions for site (98%) and "old lacunar infarct" (61%) size. Cavitated (vs noncavitated) lesions were usually identified as lacunar lesions; with increasing white matter lesions, however, noncavitated lesions were very unlikely to be identified, even with prior imaging available (7.8%). Conclusions-Imaging definitions of lacunar lesions vary widely, in part due to variation in lesion detection and classification.A consensus for imaging definitions of small-vessel disease features would be helpful.

The epidemiology of silent brain infarction: a systematic review of population-based cohorts

“…With regard to defining SBI, inconsistent radiological criteria for diagnosing infarction have been applied. Consequently, prevalence is underestimated by definitions limiting SBIs to lacunes or lesions with cerebrospinal fluid (CSF)-like signal intensity (reflecting only completed and cavitated infarcts) in light of evidence that 30% to 80% of lacunes do not cavitate [62,63]. Conversely, more inclusive signal definitions, including lesions ≤3 mm in diameter overestimate prevalence.…”

Multimodal CT Provides Improved Performance for Lacunar Infarct Detection

“…A 30-day DWI limit was applied, because this represents an accepted time for DWI to remain sensitive for infarct detection in patients with acute ischemic stroke. 11,17 LI was defined as solitary, subcortical lesions, Յ20 mm in greatest diameter as previously defined, 15 recommended, 18 and clinically applied. 19,20 The final study cohort comprised 88 patients.…”

Stroke subtypes and factors associated with ischemic stroke in Kinshasa, Central Africa

“…In USA, several studies have examined the difference in frequency of ischemic stroke subtypes by race. Blacks are more prone to small vessel stroke than Whites 18 . LACI accounts for 20 to 25% of all ischemic strokes [19][20][21] , and this proportion is the highest in the African Americans than in the white population 22,23 .…”

“…This was most often found in the parietal lobe (73.6%) for Obajimi et al Potter et al 18 and Bailey et al 28 found lesions occurring more often in the internal capsule and caudate nucleus.…”