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Updated: Oct 23, 2025
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Assessing cortical cerebral microinfarcts on iron-sensitive MRI in cerebral small vessel disease
Kim Wiegertjes1, Kwok-Shing Chan2, Annemieke Ter Telgte1
1Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
Abstract:
Recent studies suggest that a subset of cortical microinfarcts may be identifiable on T2* but invisible on T1 and T2 follow-up images. We aimed to investigate whether cortical microinfarcts are associated with iron accumulation after the acute stage. The RUN DMC - InTENse study is a serial MRI study including individuals with cerebral small vessel disease (SVD). 54 Participants underwent 10 monthly 3 T MRIs, including diffusion-weighted imaging, quantitative R1 (=1/T1), R2 (=1/T2), and R2* (=1/T2*) mapping, from which MRI parameters within areas corresponding to microinfarcts and control region of interests (ROIs) were retrieved within 16 participants. Finally, we compared pre- and post-lesional values with repeated measures ANOVA and post-hoc paired t-tests using the mean difference between lesion and control ROI values. We observed 21 acute cortical microinfarcts in 7 of the 54 participants (median age 69 years [IQR 66-74], 63% male). R2* maps demonstrated an increase in R2* values at the moment of the last available follow-up MRI (median [IQR], 5 [5-14] weeks after infarction) relative to prelesional values (p = .08), indicative of iron accumulation. Our data suggest that cortical microinfarcts are associated with increased R2* values, indicative of iron accumulation, possibly due to microhemorrhages, neuroinflammation or neurodegeneration, awaiting histopathological verification.
Insights
Cortical microinfarcts show increased R2* values, indicating iron accumulation after the acute stage. This finding suggests potential microhemorrhages or neuroinflammation in small vessel disease patients.
Area of Science:
- Neuroimaging
- Cerebrovascular Diseases
- Neuropathology
Background:
- Cortical microinfarcts (CMIs) may be detectable on T2* MRI but not T1/T2.
- The association between CMIs and post-acute iron accumulation is not well understood.
Purpose of the Study:
- To investigate if CMIs are linked to iron accumulation after the acute phase.
- To explore the role of R2* mapping in detecting these changes.
Main Methods:
- Serial 3T MRI scans (including R1, R2, R2* mapping) were performed monthly for 10 months.
- MRI parameters were analyzed in CMIs and control regions in 16 participants from the RUN DMC - InTENse study.
- Repeated measures ANOVA and paired t-tests compared pre- and post-lesional ROI values.
Main Results:
- 21 acute CMIs were identified in 7 participants with cerebral small vessel disease.
- R2* values increased in CMIs at follow-up MRIs (5-14 weeks post-infarction) compared to pre-lesional values (p=0.08).
- Increased R2* suggests iron accumulation in CMIs.
Conclusions:
- CMIs are associated with elevated R2* values, indicative of iron accumulation.
- This iron accumulation may result from microhemorrhages, neuroinflammation, or neurodegeneration.
- Further histopathological studies are needed for verification.
