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Updated: Mar 2, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Cortical Microinfarcts in Patients with Middle Cerebral Artery Stenosis
Xinyi Leng1, Hui Fang2, Yuehua Pu3
1Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Background:
Cortical microinfarcts (CMIs) have been correlated to cognitive decline and dementia. It was previously considered only visible on microscope, but was recently reported to be visible on 3.0 Tesla magnetic resonance imaging (MRI) and linked to presence of intracranial stenosis. We aimed to investigate CMIs on 3.0 Tesla MRI in patients with M1 middle cerebral artery (MCA-M1) stenosis.
Methods:
Patients with a recent non-cardioembolic ischemic stroke or transient ischemic attack and an atherosclerotic MCA-M1 stenosis were recruited. The severity of MCA stenosis was defined as moderate (50%-69%) or severe (70%-99% or focal flow void) on time-of-flight MR angiography (MRA). The distal to proximal signal intensity ratio (SIR) of MCA stenosis was measured on time-of-flight MRA to represent its hemodynamic significance. The presence of CMI(s) in the ipsilateral hemisphere was assessed on axial T1- or T2-weighted images and T2-weighted fluid-attenuated inversion-recovery images.
Results:
Overall, 86 patients (mean age: 62.8 years; 77.9% males) were analyzed, 66 (76.7%) and 20 (23.3%), respectively, having moderate and severe MCA-M1 stenoses. The median SIR was .91. Forty-five (52.3%) patients had ipsilateral CMI(s). Multivariate logistic regression showed a history of dyslipidemia (odds ratio [OR] = 6.83, P = .008), and an SIR lower than the median (OR = 4.73, P = .014) were independently associated with presence of CMI(s) in ipsilateral hemisphere to an MCA-M1 stenosis.
Conclusions:
Patients with stroke and intracranial stenosis had a high burden of CMI. Except for a history of dyslipidemia, the hemodynamic significance of the arterial stenosis may contribute to the presence of ipsilateral CMI(s) in these patients, which warrants further investigation in prospective, longitudinal studies.
Insights
Cortical microinfarcts (CMIs) are visible on 3.0T MRI in patients with middle cerebral artery stenosis. Hemodynamic significance of stenosis and dyslipidemia are associated with CMIs.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Cortical microinfarcts (CMIs) are linked to cognitive decline and dementia.
- Previously only visible microscopically, CMIs are now detectable via 3.0 Tesla MRI.
- Recent findings associate CMIs with intracranial stenosis.
Purpose of the Study:
- To investigate the presence of CMIs using 3.0 Tesla MRI.
- To assess CMIs in patients specifically with M1 middle cerebral artery (MCA-M1) stenosis.
Main Methods:
- Recruited patients with recent ischemic stroke/TIA and MCA-M1 stenosis.
- Assessed MCA stenosis severity (moderate/severe) using time-of-flight MR angiography (MRA).
- Measured signal intensity ratio (SIR) on MRA for hemodynamic significance; assessed CMI presence on MRI sequences.
Main Results:
- 86 patients analyzed (mean age 62.8, 77.9% male); 52.3% had ipsilateral CMIs.
- Moderate and severe MCA-M1 stenoses were present in 76.7% and 23.3% of patients, respectively.
- Independent predictors for CMIs included dyslipidemia history (OR=6.83) and low SIR (OR=4.73).
Conclusions:
- Patients with stroke and intracranial stenosis exhibit a high CMI burden.
- Hemodynamic significance of arterial stenosis, beyond dyslipidemia, may contribute to ipsilateral CMIs.
- Further prospective, longitudinal studies are warranted to confirm these findings.
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