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Cerebellar infarct patterns: The SMART-Medea study
Laurens J L De Cocker1, Mirjam I Geerlings2, Nolan S Hartkamp1
1Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Objective:
Previous studies on cerebellar infarcts have been largely restricted to acute infarcts in patients with clinical symptoms, and cerebellar infarcts have been evaluated with the almost exclusive use of transversal MR images. We aimed to document the occurrence and 3D-imaging patterns of cerebellar infarcts presenting as an incidental finding on MRI.
Methods:
We analysed the 1.5 Tesla MRI, including 3D T1-weighted datasets, of 636 patients (mean age 62 ± 9 years, 81% male) from the SMART-Medea study. Cerebellar infarct analyses included an assessment of size, cavitation and gliosis, of grey and white matter involvement, and of infarct topography.
Results:
One or more cerebellar infarcts (mean 1.97; range 1-11) were detected in 70 out of 636 patients (11%), with a total amount of 138 infarcts identified, 135 of which showed evidence of cavitation. The average mean axial diameter was 7 mm (range 2-54 mm), and 131 infarcts (95%) were smaller than 20 mm. Hundred-thirty-four infarcts (97%) involved the cortex, of which 12 in combination with subcortical white matter. No infarcts were restricted to subcortical branches of white matter. Small cortical infarcts involved the apex of a deep (pattern 1) or shallow fissure (pattern 2), or occurred alongside one (pattern 3) or opposite sides (pattern 4) of a fissure. Most (87%) cerebellar infarcts were situated in the posterior lobe.
Conclusions:
Small cerebellar infarcts proved to be much more common than larger infarcts, and preferentially involved the cortex. Small cortical infarcts predominantly involved the posterior lobes, showed sparing of subcortical white matter and occurred in characteristic topographic patterns.
Insights
Small cerebellar infarcts are common incidental findings on MRI, often affecting the cortex and posterior lobes. These small infarcts, typically under 20 mm, show characteristic patterns and spare white matter.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Cerebellar infarct studies traditionally focus on acute, symptomatic cases.
- Previous imaging predominantly used transversal MRI sequences.
- Limited data exists on incidental cerebellar infarcts and their 3D imaging characteristics.
Purpose of the Study:
- To investigate the prevalence and 3D imaging patterns of cerebellar infarcts found incidentally on MRI.
- To characterize the topography, size, and tissue involvement of these infarcts.
Main Methods:
- Analysis of 1.5 Tesla MRI 3D T1-weighted datasets from 636 patients in the SMART-Medea study.
- Assessment of infarct characteristics: size, cavitation, gliosis, grey/white matter involvement, and topography.
- Detailed evaluation of infarct location and relationship to cerebellar fissures.
Main Results:
- 11% of patients (70/636) had one or more cerebellar infarcts (mean 1.97 per patient).
- 138 infarcts were identified, predominantly small (95% < 20 mm) and cortical (97%).
- Most infarcts (87%) were in the posterior lobe, often involving fissures but sparing subcortical white matter.
Conclusions:
- Small cerebellar infarcts are more common than previously recognized, particularly as incidental findings.
- These infarcts preferentially involve the cerebellar cortex, especially in the posterior lobes.
- Characteristic topographic patterns of small cortical infarcts were observed, with white matter sparing.
