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MR detection of microhemorrhages in neurologically healthy adults
Y Tsushima1, Y Tanizaki, J Aoki
1Department of Radiology, Motojima General Hospital, Ohta, Gunma, Japan. yoshito@xa2.so-net.ne.jp
Abstract:
T2*-weighted gradient-echo (GE) magnetic resonance images frequently demonstrate small hypointense lesions in patients with systemic hypertension and spontaneous hematomas. These lesions have been suspected to represent subclinical microhemorrhages. We examined the incidence of these lesions in neurologically healthy adults, and the factors associated with them. Axial T2*-weighted GE images (TR = 1,000 ms, TE = 30 ms, flip angle = 20 degrees) were obtained in addition to conventional T1- and T2-weighted spin echo images in 450 neurologically healthy Japanese adults (289 men and 161 women; age 52.9 +/- 7.7 years, range 24-84). The overall incidence of small hypointense lesions was 3.1% (14/450), and these lesions were closely related to systemic hypertension (P < 0.0001) and heavy cigarette smoking (>20 cigarettes per day; P=0.003). Although the incidence of hypointense lesions was lower in neurologically healthy adults than in the reported incidence in patients with a hemorrhagic history, the presence of these lesions was related to the risk factors for primary intracerebral hemorrhage even in the neurologically healthy adults.
Insights
Small hypointense lesions on MRI, possibly indicating silent brain bleeds, are linked to high blood pressure and smoking in healthy adults. These findings suggest these lesions may signal future stroke risk even without prior symptoms.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- T2*-weighted gradient-echo (GE) magnetic resonance imaging (MRI) often reveals small hypointense lesions in patients with hypertension or hematomas.
- These lesions are hypothesized to represent subclinical microhemorrhages, indicating small, undetected bleeding in the brain.
Purpose of the Study:
- To investigate the incidence of these small hypointense lesions in neurologically healthy adults.
- To identify factors associated with the presence of these lesions in a healthy population.
Main Methods:
- 450 neurologically healthy Japanese adults underwent axial T2*-weighted GE MRI, alongside conventional T1- and T2-weighted spin echo MRI.
- Data analysis focused on the presence of small hypointense lesions and their correlation with demographic and clinical factors.
Main Results:
- The overall incidence of small hypointense lesions was 3.1% (14/450) in the study cohort.
- A significant association was found between these lesions and systemic hypertension (P < 0.0001).
- Heavy cigarette smoking (>20 cigarettes/day) was also significantly related to the presence of these lesions (P=0.003).
Conclusions:
- Even in neurologically healthy individuals, the presence of small hypointense lesions on T2*-weighted GE MRI is associated with key risk factors for primary intracerebral hemorrhage, namely hypertension and smoking.
- These findings suggest that these lesions may serve as an indicator of increased risk for future hemorrhagic events, even in the absence of overt neurological symptoms or history.