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Updated: Apr 10, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
MRI Characteristics of the Evolution of Supratentorial Recent Small Subcortical Infarcts
Shuhei Okazaki1, Eva Hornberger1, Martin Griebe1
1Department of Neurology, UniversitätsMedizin Mannheim, University of Heidelberg , Mannheim , Germany.
Objective:
Morphological changes of recent small subcortical infarcts are not well defined. The purpose of the present study was to describe the MRI characteristics of the evolution for this stroke subtype.
Methods:
We conducted a retrospective review of patients diagnosed with definite supratentorial recent small subcortical infarcts according to the ASCO classification with baseline and follow-up MRI (≥90 days of stroke onset). We investigated the incidence of cavity formation, the infarct volume change, and the positional relationship between infarct lesions and preexisting white matter hyperintensities (WMHs) of presumed vascular origin.
Results:
We identified 62 patients with a median age of 71 years (range: 30-87). Median follow-up period was 26 months (range: 3-99). Cavity formation was observed in 38 infarct lesions (61%). Eighteen lesions (29%) were partially adjacent to WMHs and 7 (11%) were fused into WMHs. In a multiple logistic regression analysis, age [odds ratio per 5-year increase: 1.34; 95% confidence interval (CI): 1.03-1.80; p = 0.03] and baseline infarct volume (odds ratio per 1-ml increase: 4.7; 95% CI: 1.6-19.7; p = 0.003) were independent predictors of cavity formation. There was a significant volume reduction between baseline and follow-up infarct lesions (median volume reduction rate: 44%).
Conclusion:
More than one-third of recent small subcortical infarcts do not lead to cavity formation and 40% of infarct lesions overlap with WMHs. Our data indicate the continuity between recent small subcortical infarcts and WMHs.
Insights
Small subcortical infarcts show significant evolution, with 61% forming cavities. Age and infarct volume predict cavity formation, and infarcts often overlap with white matter hyperintensities.
Area of Science:
- Neurology
- Radiology
- Stroke Research
Background:
- Small subcortical infarcts are a common stroke subtype.
- The long-term morphological changes of these infarcts are not well-characterized.
- Understanding infarct evolution is crucial for patient management and prognosis.
Purpose of the Study:
- To describe the magnetic resonance imaging (MRI) characteristics of evolving recent small subcortical infarcts.
- To investigate the incidence of cavity formation, infarct volume changes, and spatial relationships with white matter hyperintensities (WMHs).
Main Methods:
- Retrospective review of patients with supratentorial recent small subcortical infarcts.
- Analysis of baseline and follow-up MRI scans (≥90 days post-stroke).
- Assessment of cavity formation, infarct volume reduction, and proximity to WMHs.
Main Results:
- 61% of infarcts developed cavities; cavity formation was predicted by older age and larger baseline infarct volume.
- A median infarct volume reduction of 44% was observed.
- 29% of lesions were adjacent to WMHs, and 11% fused with WMHs, indicating continuity.
Conclusions:
- Over one-third of small subcortical infarcts do not form cavities.
- A significant proportion of infarcts demonstrate overlap or fusion with pre-existing WMHs.
- These findings highlight the dynamic nature of small subcortical infarcts and their relationship with vascular brain changes.
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