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Prevalence and clinical relevance of diffusion-weighted imaging lesions: The Rotterdam study

Saima Hilal1, Laurien G A Baaij1, Marius de Groot1

  • 1From the Departments of Radiology and Nuclear Medicine (S.H., M.d.G., W.J.N., M.W.V.), Epidemiology (S.H., L.G.A.B., M.K.I., M.A.I., M.W.V.), Medical Informatics (M.d.G., W.J.N.), and Neurology (M.K.I.), Erasmus University Medical Center, Rotterdam, the Netherlands.

Neurology
|August 9, 2019
PubMed
Abstract

Insights

Asymptomatic diffusion-weighted image (DWI) lesions are linked to cerebrovascular disease markers and worse cognition. These brain lesions increase stroke risk, highlighting potential targets for future interventions.

Area of Science:

  • Neurology
  • Radiology
  • Neuroimaging

Background:

  • Diffusion-weighted imaging (DWI) detects acute ischemic changes in the brain.
  • Cerebrovascular disease and neurodegeneration impact cognitive function.
  • Understanding DWI lesion evolution is crucial for predicting neurological outcomes.

Purpose of the Study:

  • To investigate the association between DWI lesions and markers of cerebrovascular disease, neurodegeneration, and cognitive function.
  • To explore the evolution of DWI lesions over time.
  • To determine the link between DWI lesions and the risk of dementia, stroke, or transient ischemic attack (TIA).

Main Methods:

  • Analysis of 2,176 participants from the Rotterdam Study with baseline MRI scans.
  • Inspection of DWIs for acute or subacute lesions.
  • Assessment of cerebrovascular disease markers, brain tissue segmentation, microstructural integrity, and cognitive performance.
  • Evaluation of DWI lesion evolution on follow-up MRI scans.

Main Results:

  • 1.5% of participants had DWI lesions, associated with lacunes, white matter hyperintensities (WMHs), and reduced white matter integrity.
  • Individuals with DWI lesions showed poorer performance on the Stroop test.
  • Follow-up revealed DWI lesions evolving into WMHs (58.8%), cavitation (17.6%), or cortical cerebral microinfarcts (5.9%), with some resolving (17.6%).
  • DWI lesions at baseline significantly increased the risk of future strokes (HR 3.72).

Conclusions:

  • Asymptomatic DWI lesions correlate with cerebral small vessel disease, impaired microstructural integrity, and cognitive deficits.
  • The presence of DWI lesions is a significant predictor of increased stroke risk.
  • Further research is needed to evaluate the efficacy of screening and treating DWI lesions to mitigate stroke burden.

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