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The role of small diffusion-weighted imaging lesions in cerebral small vessel disease

Kim Wiegertjes1, Annemieke Ter Telgte1, Pedro B Oliveira1

  • 1From the Department of Neurology (K.W., A.t.T., P.B.O., E.M.C.v.L., M.I.B., I.W.M.v.U., H.M.v.d.H., C.J.M.K., A.M.T., F.-E.d.L.) and Center for Cognitive Neuroimaging (D.G.N.), Donders Institute for Brain, Cognition and Behavior, and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboud University Medical Center; and Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands.

Neurology
|September 19, 2019
PubMed
Abstract

Insights

Over 3% of individuals with cerebral small vessel disease (SVD) have asymptomatic diffusion-weighted imaging-positive (DWI+) lesions. These DWI+ lesions contribute to SVD progression but do not fully explain MRI marker changes, indicating other factors are involved.

Area of Science:

  • Neurology
  • Radiology
  • Neuroimaging

Background:

  • Cerebral small vessel disease (SVD) is a common condition affecting the brain's small blood vessels.
  • Diffusion-weighted imaging (DWI) can detect acute ischemic lesions, but their prevalence and role in SVD progression are not fully understood.

Purpose of the Study:

  • To determine the frequency of asymptomatic diffusion-weighted imaging-positive (DWI+) lesions in SVD patients.
  • To investigate the association between DWI+ lesions and the development and progression of SVD markers on MRI.

Main Methods:

  • Analysis of 1,152 DWI scans from 503 individuals with SVD in the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort (RUN DMC) study.
  • Assessment of lesion evolution using follow-up MRI scans (fluid-attenuated inversion recovery, T1, T2*) and examination of associations with SVD progression markers (white matter hyperintensities, lacunes, microbleeds).

Main Results:

  • 3.4% of individuals had DWI+ lesions, which were associated with older age, hypertension history, and a higher burden of existing SVD markers.
  • Of DWI+ lesions with follow-up, 61% evolved into white matter hyperintensities and 35% into cavities.
  • DWI+ lesions significantly correlated with annual increases in white matter hyperintensities and the incidence of lacunes and microbleeds.

Conclusions:

  • Asymptomatic DWI+ lesions are present in over 3% of individuals with SVD.
  • While DWI+ lesions contribute to SVD progression, they do not entirely account for the observed changes in SVD MRI markers, suggesting additional pathogenic mechanisms beyond acute ischemia.

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