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Magnetic resonance imaging white matter hyperintensities and mechanism of ischemic stroke
R Mäntylä1, H J Aronen, O Salonen
1Department of Radiology, Memory Research Unit, Helsinki University Central Hospital, Finland. ritta.mantyla@helsinki.fi
Background And Purpose:
We sought to determine the relations between infarct subtype and white matter hyperintensities (WMHIs) on MRI.
Materials And Methods:
We studied 395 ischemic stroke patients with 1. 0-T MRI. The number of lacunar, border-zone, and cortical infarcts was registered. WMHIs were analyzed in 6 areas. Univariate and multivariate statistical analyses were used to find the risk factors for different infarct subtypes and to study the connections between WMHIs and brain infarcts.
Results:
Lacunar infarcts were associated with hypertension (odds ratio [OR], 1.79; 95% CI, 1.17 to 2.73), alcohol consumption (OR, 1.96; 95% CI, 1.17 to 3.28), and age (OR, 1. 03; 95% CI, 1.00 to 1.06). Border-zone infarcts were associated with carotid atherosclerosis (OR, 2.20; 95% CI, 1.15 to 4.19). Atrial fibrillation (OR, 3.02; 95% CI, 1.66 to 5.50) and carotid atherosclerosis (OR, 1.94; 95% CI, 1.12 to 3.36) were independent positive predictors, and history of hyperlipidemia (OR, 0.44; 95% CI, 0.26 to 0.75) and migraine (OR, 0.48; 95% CI, 0.25 to 0.93) were negative predictors for cortical infarcts. Patients with lacunar infarcts had more severe WMHIs than patients with nonlacunar infarcts in all WM areas (P
Conclusions:
Various infarct subtypes have different risk profiles. The association between lacunar infarcts and WMHIs supports the concept of small-vessel disease underlying these 2 phenomena. The connection between border-zone infarcts and periventricular WMHIs again raises the question of the disputed periventricular vascular border zone.
Insights
Different types of brain infarcts have distinct risk factors and associations with white matter hyperintensities (WMHIs). Lacunar infarcts link to small-vessel disease, while border-zone infarcts connect to periventricular WMHIs.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Research
Background:
- White matter hyperintensities (WMHIs) are common findings on MRI in stroke patients.
- Understanding the relationship between infarct subtypes and WMHIs is crucial for diagnosis and treatment.
Purpose of the Study:
- To investigate the associations between different ischemic stroke infarct subtypes (lacunar, border-zone, cortical) and the presence and severity of WMHIs.
- To identify risk factors specific to each infarct subtype.
Main Methods:
- A cohort of 395 ischemic stroke patients underwent 1.0-T MRI.
- Infarct subtypes were quantified, and WMHIs were assessed in six distinct brain regions.
- Univariate and multivariate statistical analyses were employed to determine risk factors and associations.
Main Results:
- Lacunar infarcts were associated with hypertension, alcohol consumption, and age.
- Border-zone infarcts showed a link to carotid atherosclerosis.
- Cortical infarcts were predicted by atrial fibrillation and carotid atherosclerosis, while hyperlipidemia and migraine were negative predictors.
- Patients with lacunar infarcts exhibited more severe WMHIs compared to non-lacunar infarcts.
- Border-zone infarct patients presented with severe periventricular WMHIs.
Conclusions:
- Infarct subtypes possess unique risk profiles and distinct relationships with WMHIs.
- The link between lacunar infarcts and WMHIs supports the concept of underlying small-vessel disease.
- The association between border-zone infarcts and periventricular WMHIs warrants further investigation into the periventricular vascular border zone.