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Updated: Jun 19, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Associations between microinfarcts and other macroscopic vascular findings on neuropathologic examination in 2
W T Longstreth1, Joshua A Sonnen, Thomas D Koepsell
1Department of Neurology, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104-2420, USA. wl@u.washington.edu
Abstract:
Clinicians may undervalue brain microinfarcts because they are defined by neuropathology and not seen on magnetic resonance imaging (MRI). We sought to identify what neuropathologic vascular findings-likely to be evident on brain MRI during life-would predict the presence of microinfarcts. We sought associations between such findings and microinfarcts in neuropathology databases from the National Alzheimer's Coordinating Center (NACC) and the Adult Changes in Thought (ACT) study. Considering only subjects 65 years or older at death, microinfarcts were evaluated in 6189 from NACC and 219 from ACT. Despite different definitions being used, microinfarcts were common in both studies (19.7% in NACC and 16.0% in ACT), and their frequency increased significantly with age. In NACC specimens, after controlling for age and sex in multivariable models, microinfarcts were strongly associated with macroinfarcts [odds ratio (OR): 4.4, 95% confidence interval (CI): 3.8, 5.0], leukoencephalopathy (OR: 2.6, 95% CI: 2.1, 3.3), and hemorrhages (OR: 2.0, 95% CI: 1.6, 2.6). Similarly in the ACT specimens, microinfarcts were strongly associated with macroinfarcts (OR: 2.9, 95% CI: 1.4, 6.3). These neuropathologic associations suggest that people whose cranial MRI shows macroinfarcts, hemorrhages, or leukoencephalopathy are more likely also to have microinfarcts.
Insights
Brain microinfarcts are common in older adults and often associated with other vascular findings like macroinfarcts, hemorrhages, and leukoencephalopathy visible on MRI.
Area of Science:
- Neuropathology
- Neuroimaging
- Geriatric Medicine
Background:
- Brain microinfarcts are neuropathologically defined and often undetected by magnetic resonance imaging (MRI).
- Their clinical significance may be underestimated due to challenges in in-vivo detection.
- Understanding predictors of microinfarcts could improve clinical assessment and patient outcomes.
Purpose of the Study:
- To identify neuropathologic vascular findings predictive of microinfarcts.
- To determine if these findings are detectable via brain MRI during life.
- To associate neuropathologic markers with microinfarct presence in aging populations.
Main Methods:
- Analysis of neuropathology databases from the National Alzheimer's Coordinating Center (NACC) and the Adult Changes in Thought (ACT) study.
- Inclusion of subjects aged 65 years or older at death.
- Statistical modeling to assess associations between microinfarcts and vascular findings (macroinfarcts, leukoencephalopathy, hemorrhages), controlling for age and sex.
Main Results:
- Microinfarcts were prevalent in both NACC (19.7%) and ACT (16.0%) cohorts, increasing with age.
- In NACC, microinfarcts showed strong associations with macroinfarcts (OR: 4.4), leukoencephalopathy (OR: 2.6), and hemorrhages (OR: 2.0).
- The ACT study also found a significant association between microinfarcts and macroinfarcts (OR: 2.9).
Conclusions:
- Neuropathologic findings of macroinfarcts, hemorrhages, and leukoencephalopathy are significant predictors of microinfarcts.
- These vascular markers, often visible on brain MRI, suggest a higher likelihood of co-occurring microinfarcts.
- Integrating MRI findings of these vascular pathologies may aid in identifying individuals with microinfarcts.
