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Microinfarct disruption of white matter structure: a longitudinal diffusion tensor analysis.

Eitan Auriel1, Brian L Edlow1, Yael D Reijmer1

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Summary

Small asymptomatic brain infarctions detected by diffusion-weighted imaging (DWI) cause lasting white matter damage. These lesions may contribute to cognitive decline associated with small-vessel disease.

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Area of Science:

  • Neuroimaging
  • Neurology
  • White Matter Diseases

Background:

  • Small asymptomatic lesions are increasingly detected using diffusion-weighted imaging (DWI).
  • The long-term microstructural impact of these lesions on white matter is not well understood.

Purpose of the Study:

  • To evaluate the local effect of small asymptomatic infarctions on white matter microstructure.
  • To use longitudinal diffusion tensor imaging (DTI) to assess changes over time.

Main Methods:

  • Subjects with probable cerebral amyloid angiopathy and DWI lesions underwent serial MRI.
  • Regions of interest (ROIs) in lesioned and contralateral healthy white matter were analyzed.
  • DTI parameters (fractional anisotropy, mean diffusivity) were quantified before and after lesion detection.

Main Results:

  • A significant decrease in FA and increase in MD ratios in lesioned ROIs was observed post-lesion.
  • No visible changes were seen on conventional MRI, though small T1 hypointensities appeared in some lesions.
  • No microstructural changes were detected in larger white matter tract segments or bundles.

Conclusions:

  • Asymptomatic DWI lesions induce chronic local microstructural injury in white matter.
  • The cumulative effect of these lesions may contribute to vascular cognitive impairment.