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Updated: Mar 15, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Microbleeds on MRI are associated with microinfarcts on autopsy in cerebral amyloid angiopathy
Arne Lauer1, Susanne J van Veluw2, Christopher M William2
1From the Hemorrhagic Stroke Research Program (A.L., S.J.v.V., A.C., D.R., A.V., A.A., S.M.-R., E.M.G., S.M.G., A.V.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Department of Neurology (S.J.v.V., G.J.B.), Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands; Department of Pathology (C.M.W.), New York University Langone Medical Center, New York University School of Medicine; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; and C.S. Kubik Laboratory for Neuropathology (M.F.), Massachusetts General Hospital, Harvard Medical School, Boston. arne.lauer@gmx.de.
Objectives:
To identify in vivo MRI markers that might correlate with cerebral microinfarcts (CMIs) on autopsy in patients with cerebral amyloid angiopathy (CAA).
Methods:
We included patients with neuropathologic evidence of CAA on autopsy and available antemortem brain MRI. Clinical characteristics and in vivo MRI markers of CAA-related small vessel disease were recorded, including white matter hyperintensities, cerebral microbleeds, cortical superficial siderosis, and centrum semiovale perivascular spaces. In addition, the presence of intracerebral hemorrhage on MRI was assessed. Evaluation of the presence and number of CMIs was performed in 9 standard histology sections.
Results:
Of 49 analyzed patients with CAA, CMIs were present in 36.7%. The presence of ≥1 CMIs on autopsy was associated with higher numbers of microbleeds on antemortem MRI (median 8 [interquartile range 2.5-33.0] vs 1 [interquartile range 0-3], p = 0.003) and with the presence of intracerebral hemorrhage (44.4% vs 16.1%, p = 0.03). No associations between CMIs and other in vivo MRI markers of CAA were found. In a multivariable model adjusted for severe CAA pathology, higher numbers of microbleeds were independent predictors of the presence of CMIs on pathology.
Conclusions:
CMIs are a common finding at autopsy in patients with CAA. The strong association between MRI-observed microbleeds and CMIs at autopsy may suggest a shared underlying pathophysiologic mechanism between these lesions.
Insights
Cerebral microinfarcts (CMIs) are common in cerebral amyloid angiopathy (CAA). Autopsy-confirmed CMIs strongly correlate with MRI-detected microbleeds, suggesting a shared cause.
Area of Science:
- Neurology
- Neuroimaging
- Pathology
Background:
- Cerebral amyloid angiopathy (CAA) is a common cerebrovascular disease.
- Cerebral microinfarcts (CMIs) are small lesions that can occur in the brain.
- Identifying in vivo markers for CMIs is crucial for understanding CAA progression.
Purpose of the Study:
- To identify in vivo magnetic resonance imaging (MRI) markers that correlate with cerebral microinfarcts (CMIs) found on autopsy in patients with CAA.
Main Methods:
- Retrospective analysis of patients with autopsy-proven CAA and available antemortem brain MRI.
- Assessment of in vivo MRI markers including white matter hyperintensities, cerebral microbleeds, cortical superficial siderosis, and perivascular spaces.
- Histological evaluation of 9 brain sections to determine the presence and number of CMIs.
Main Results:
- CMIs were present in 36.7% of the 49 analyzed CAA patients.
- Autopsy-confirmed CMIs were associated with a higher number of microbleeds on MRI (p = 0.003) and the presence of intracerebral hemorrhage (p = 0.03).
- Higher numbers of microbleeds on MRI were independent predictors of CMIs in multivariable analysis adjusted for severe CAA pathology.
Conclusions:
- CMIs are a frequent finding in patients with CAA at autopsy.
- The significant association between MRI-detected microbleeds and autopsy-confirmed CMIs suggests a common underlying pathophysiologic mechanism.
