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Updated: Aug 3, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Temporal Dynamics of Cortical Microinfarcts in Cerebral Small Vessel Disease
Annemieke Ter Telgte1, Kim Wiegertjes1, Benno Gesierich2
1Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands.
Importance:
Neuropathology studies show a high prevalence of cortical microinfarcts (CMIs) in aging individuals, especially in patients with cerebrovascular disease and dementia. However, most, are invisible on T1- and T2-weighted magnetic resonance imaging (MRI), raising the question of how to explain this mismatch. Studies on small acute infarcts, detected on diffusion-weighted imaging (DWI), suggest that infarcts are largest in their acute phase and reduce in size thereafter. Therefore, we hypothesized that a subset of the CMI that are invisible on MRI can be detected on MRI in their acute phase. However, to our knowledge, a serial imaging study investigating the temporal dynamics of acute CMI (A-CMI) is lacking.
Objective:
To determine the prevalence of chronic CMI (C-CMI) and the cumulative incidence and temporal dynamics of A-CMI in individuals with cerebral small vessel disease (SVD).
Design, Setting, Participants And Exposures:
The RUN DMC-Intense study is a single-center hospital-based prospective cohort study on SVD performed between March 2016 and November 2017 and comprising 10 monthly 3-T MRI scans, including high-resolution DWI, 3-dimensional T1, 3-dimensional fluid-attenuated inversion recovery, and T2. One hundred six individuals from the previous longitudinal RUN DMC study were recruited based on the presence of progression of white matter hyperintensities on MRI between 2006 and 2015 and exclusion of causes of cerebral ischemia other than SVD. Fifty-four individuals (50.9%) participated. The median total follow-up duration was 39.5 weeks (interquartile range, 37.8-40.3). Statistical data analysis was performed between May and October 2019.
Main Outcomes And Measures:
We determined the prevalence of C-CMI using the baseline T1, fluid-attenuated inversion recovery, and T2 scans. Monthly high-resolution DWI scans (n = 472) were screened to determine the cumulative incidence of A-CMI. The temporal dynamics of A-CMI were determined based on the MRI scans collected during the first follow-up visit after A-CMI onset and the last available follow-up visit.
Results:
The median age of the cohort at baseline MRI was 69 years (interquartile range, 66-74 years) and 34 participants (63%) were men. The prevalence of C-CMI was 35% (95% CI, 0.24-0.49). Monthly DWI detected 21 A-CMI in 7 of 54 participants, resulting in a cumulative incidence of 13% (95% CI, 0.06-0.24). All A-CMI disappeared on follow-up MRI.
Conclusions And Relevance:
Acute CMI never evolved into chronically MRI-detectable lesions. We suggest that these A-CMI underlie part of the submillimeter C-CMI encountered on neuropathological examination and thereby provide a source for the high CMI burden on neuropathology.
Insights
Newly detected acute cortical microinfarcts (A-CMI) are often invisible on follow-up MRI scans and may explain the high prevalence of these lesions found in neuropathology studies of aging brains.
Area of Science:
- Neurology
- Neuroradiology
- Cerebrovascular Disease
Background:
- Cortical microinfarcts (CMIs) are common in aging brains, particularly in patients with cerebrovascular disease and dementia.
- Most CMIs are not visible on standard MRI, creating a diagnostic challenge.
- Acute CMIs (A-CMI) may be detectable in their early stages, but their temporal dynamics are poorly understood.
Purpose of the Study:
- To investigate the prevalence and temporal dynamics of A-CMI in individuals with cerebral small vessel disease (SVD).
- To determine if A-CMI evolve into chronic lesions detectable by MRI.
Main Methods:
- A prospective cohort study (RUN DMC-Intense) involving 54 participants with SVD.
- Monthly 3-T MRI scans, including high-resolution diffusion-weighted imaging (DWI), were acquired over a median of 39.5 weeks.
- Statistical analysis was performed to assess CMI incidence and temporal changes.
Main Results:
- The prevalence of chronic CMIs (C-CMI) was 35%.
- A cumulative incidence of 13% for A-CMI was detected via monthly DWI scans in 7 participants.
- All detected A-CMI resolved completely on subsequent MRI scans.
Conclusions:
- Acute CMIs detected by DWI in SVD patients are transient and do not evolve into chronically visible lesions on MRI.
- These transient A-CMI likely represent a significant portion of the submillimeter CMIs observed in neuropathological studies.
- The findings help explain the discrepancy between MRI-detected and neuropathologically confirmed CMI burden.
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