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Updated: Jun 18, 2026
Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
White matter lesions and lacunar infarcts are independently and differently associated with brain atrophy: the
Auke P A Appelman1, Koen L Vincken, Yolanda van der Graaf
1Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Objective:
To investigate the independent association of white matter lesions (WML) and lacunar infarcts (LI) with measures of global brain atrophy on MRI.
Methods:
Within the SMART-MR study, a cohort study among patients with manifest arterial disease, cross-sectional analyses were performed in 840 patients (mean age 58 +/- 10 years, 80% male) without cortical, large subcortical or infratentorial infarcts. Brain segmentation was used to quantify volumes of brain tissue, cerebrospinal fluid and WML. Total brain volume, ventricular volume and cortical gray matter volume were divided by intracranial volume to obtain brain parenchymal fraction (BPF), ventricular fraction (VF) and cortical gray matter fraction (GMF). Location and number of infarcts were rated visually.
Results:
Mean +/- SD BPF was 79.3 +/- 2.8%, mean +/- SD VF was 2.01 +/- 0.95%, and mean +/- SD GMF was 36.6 +/- 3.3%. Linear regression analyses, adjusted for age, sex, vascular risk factors, intima media thickness and LI showed that in patients with moderate to severe WML (upper quartile) BPF was lower (-0.51%; 95% CI -0.93 to -0.08%), VF was higher (0.48%; 95% CI 0.31-0.65%) and GMF was lower (-1.48%; 95% CI -2.07 to -0.88%) than in patients with few WML (lower quartile). Presence of LI was associated with lower BPF (-0.52%; 95% CI -0.96 to -0.07%) and higher VF (0.25%; 95% CI 0.07-0.42%), but not with GMF, independent of WML and other potential confounders.
Conclusion:
WML are associated with total, subcortical and cortical brain atrophy, whereas LI are associated with total and subcortical atrophy, but not with cortical atrophy, suggesting an independent role for WML and LI in the pathogenesis of brain atrophy.
Insights
White matter lesions (WML) and lacunar infarcts (LI) are independently linked to brain atrophy. WML are associated with total, subcortical, and cortical atrophy, while LI are linked to total and subcortical atrophy.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- White matter lesions (WML) and lacunar infarcts (LI) are common in patients with arterial disease.
- Their independent association with global brain atrophy requires further investigation.
Purpose of the Study:
- To investigate the independent association of WML and LI with global brain atrophy measures using MRI.
Main Methods:
- Cross-sectional analysis of 840 patients from the SMART-MR study with manifest arterial disease.
- Brain segmentation quantified tissue volumes, cerebrospinal fluid, and WML to calculate brain parenchymal fraction (BPF), ventricular fraction (VF), and cortical gray matter fraction (GMF).
- Location and number of infarcts were visually rated.
Main Results:
- Moderate to severe WML were associated with lower BPF, higher VF, and lower GMF compared to few WML.
- Lacunar infarcts (LI) were associated with lower BPF and higher VF, but not GMF, independent of WML.
- Adjusted analyses controlled for age, sex, vascular risk factors, and intima media thickness.
Conclusions:
- WML are associated with total, subcortical, and cortical brain atrophy.
- LI are associated with total and subcortical atrophy, but not cortical atrophy.
- Both WML and LI play an independent role in the pathogenesis of brain atrophy.
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