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Updated: Jul 4, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Discriminating between silent cerebral infarction and deep white matter hyperintensity using combinations of three
Makoto Sasaki1, Toshinori Hirai, Toshiaki Taoka
1Advanced Medical Research Center, Iwate Medical University, Uchimaru, Morioka, Japan. masasaki@iwate-med.ac.jp
Introduction:
We attempted to determine the most appropriate combination of magnetic resonance (MR) images that can accurately detect and discriminate between asymptomatic infarction and deep white matter hyperintensity (DWMH); these lesions have different clinical implications and are occasionally confused.
Materials And Methods:
We performed an observer performance analysis using cerebral MR images of 45 individuals with or without asymptomatic small white matter infarction and/or mild DWMH who participated in a physical checkup program at four institutions. Six observers interpreted whether infarction and/or DWMH existed in combinations of two or three image types of the T1-weighted images (T1WI), T2-weighted images (T2WI), and fluid-attenuated inversion recovery (FLAIR) images. The observers' performance was evaluated with a receiver operating characteristic (ROC) analysis.
Results:
The averaged area under the ROC curve (Az) for detecting a infarction was significantly larger in the combination of all the three image types (0.95) than that in any combinations of the two image types (T1WI and FLAIR images, 0.87; T2WI and FLAIR images, 0.85; T1WI and T2WI, 0.86). The Az for detecting DWMH was significantly smaller in the combination of T1WI and T2WI (0.79) than that in other image combinations (T1WI and FLAIR, 0.89; T2WI and FLAIR, 0.91; T1WI, T2WI, and FLAIR, 0.90).
Conclusion:
The combination of T1WI, T2WI, and FLAIR images is required to accurately detect both small white matter infarction and mild DWMH.
Insights
The combination of T1-weighted, T2-weighted, and FLAIR magnetic resonance imaging sequences is essential for accurately detecting both asymptomatic infarction and deep white matter hyperintensity (DWMH). This approach improves diagnostic accuracy for these distinct cerebral lesions.
Area of Science:
- Radiology and Neuroradiology
- Medical Imaging Analysis
- Cerebrovascular Disease Research
Background:
- Differentiating asymptomatic infarction from deep white matter hyperintensity (DWMH) on MRI is clinically significant.
- These conditions share imaging characteristics, leading to potential diagnostic confusion.
Purpose of the Study:
- To identify the optimal combination of magnetic resonance (MR) imaging sequences for accurate detection and differentiation of asymptomatic infarction and DWMH.
- To evaluate observer performance in distinguishing these lesions using various MR image combinations.
Main Methods:
- Observer performance analysis using cerebral MR images from 45 participants.
- Six observers interpreted the presence of infarction and/or DWMH using combinations of T1-weighted images (T1WI), T2-weighted images (T2WI), and FLAIR images.
- Receiver operating characteristic (ROC) analysis was employed to evaluate observer performance.
Main Results:
- The combination of T1WI, T2WI, and FLAIR yielded the highest diagnostic accuracy (Az = 0.95) for detecting infarction.
- For DWMH detection, combinations including FLAIR (T1WI/FLAIR Az = 0.89, T2WI/FLAIR Az = 0.91) and all three sequences (Az = 0.90) showed superior performance compared to T1WI/T2WI (Az = 0.79).
Conclusions:
- The combined use of T1WI, T2WI, and FLAIR MR imaging sequences is necessary for the accurate detection and differentiation of both small white matter infarction and mild DWMH.
- This comprehensive imaging approach enhances diagnostic confidence in identifying these distinct cerebrovascular pathologies.
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