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Updated: Apr 30, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Antemortem MRI findings associated with microinfarcts at autopsy
Mekala R Raman1, Gregory M Preboske1, Scott A Przybelski1
1From the Departments of Neurology (M.R.R., B.F.B., D.S.K., R.C.P.), Radiology (G.M.P., J.L.G., M.L.S., P.V., M.C.M., C.R.J., K.K.), Health Sciences Research (S.A.P.), and Pathology (J.E.P.), Mayo Clinic, Rochester, MN; and Department of Neuroscience (M.E.M., D.W.D.), Mayo Clinic, Jacksonville, FL.
Objective:
To determine antemortem MRI findings associated with microinfarcts at autopsy.
Methods:
Patients with microinfarcts (n = 22) and patients without microinfarcts (n = 44) who underwent antemortem MRI were identified from a dementia clinic-based, population-based, and community clinic-based autopsy cohort. The microinfarct and no-microinfarct groups were matched on age at MRI, age at death, sex, APOE status, Mini-Mental State Examination score, and pathologic diagnosis of Alzheimer disease. Brain infarcts were assessed on fluid-attenuated inversion recovery (FLAIR) MRI. White matter hyperintensities on FLAIR MRI and hippocampal volumes on T1-weighted MRI were quantified using automated methods. A subset of subjects with microinfarcts (n = 15) and a matched group of subjects without microinfarcts (n = 15) had serial T1-weighted MRIs and were included in an analysis of global and regional brain atrophy rates using automated methods.
Results:
The presence of cortical (p = 0.03) and subcortical (p = 0.02) infarcts on antemortem MRI was associated with presence of microinfarcts at autopsy. Higher numbers of cortical (p = 0.05) and subcortical (p = 0.03) infarcts on antemortem MRI were also associated with presence of microinfarcts. Presence of microinfarcts was not associated with white matter hyperintensities and cross-sectional hippocampal volume on antemortem MRI. Whole-brain and regional precuneus, motor, and somatosensory atrophy rates were higher in subjects with microinfarcts compared to subjects without microinfarcts.
Conclusions:
Microinfarcts increase brain atrophy rates independent of Alzheimer disease pathology. Association between microinfarct pathology and macroinfarcts on MRI suggests either common risk factors or a shared pathophysiology and potentially common preventive targets.
Insights
Antemortem MRI can detect microinfarcts, which are associated with increased brain atrophy rates. These findings suggest shared risk factors or pathophysiology between microinfarcts and macroinfarcts, potentially indicating common preventive strategies.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Microinfarcts are small lesions often undetected by standard neuroimaging.
- Understanding the antemortem MRI correlates of microinfarcts is crucial for early diagnosis and intervention in neurodegenerative diseases.
Purpose of the Study:
- To identify specific magnetic resonance imaging (MRI) findings that correlate with the presence of microinfarcts detected at autopsy.
- To investigate the association between microinfarcts and brain atrophy rates.
Main Methods:
- A cohort study compared antemortem MRI scans of patients with and without autopsy-confirmed microinfarcts, matched for key demographic and clinical variables.
- Fluid-attenuated inversion recovery (FLAIR) MRI assessed infarcts and white matter hyperintensities, while T1-weighted MRI evaluated hippocampal volumes and brain atrophy rates using automated methods.
Main Results:
- The presence and number of cortical and subcortical infarcts on antemortem MRI were significantly associated with autopsy-confirmed microinfarcts.
- Microinfarcts were not associated with white matter hyperintensities or cross-sectional hippocampal volume.
- Subjects with microinfarcts exhibited higher rates of whole-brain and regional atrophy, particularly in the precuneus, motor, and somatosensory areas.
Conclusions:
- Antemortem MRI findings, specifically cortical and subcortical infarcts, are indicative of microinfarcts.
- Microinfarcts contribute to increased brain atrophy rates independently of Alzheimer disease pathology.
- The observed association between microinfarcts and macroinfarcts on MRI suggests common underlying risk factors or pathophysiological mechanisms, highlighting potential targets for preventive therapies.
