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Updated: Oct 11, 2025
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Association Between Cerebral Cortical Microinfarcts and Perilesional Cortical Atrophy on 3T MRI
Doeschka A Ferro1, Hugo J Kuijf2, Saima Hilal2
1From the Department of Neurology (D.A.F., G.J.B.), UMC Utrecht Brain Center, and Image Sciences Institute (H.J.K., D.v.V.), University Medical Center Utrecht, the Netherlands; Memory Aging and Cognition Centre (S.H., C.C.), Department of Pharmacology, National University of Singapore; Department of Neurology (S.J.v.V.), J.P.K. Stroke Research Center, Massachusetts General Hospital, Boston; Raffles Neuroscience Center (N.V.), Raffles Hospital; and St. Luke's Hospital (B.Y.T.), Singapore. d.a.ferro@umcutrecht.nl.
Background And Objectives:
Cerebral cortical microinfarcts (CMIs) are a novel MRI marker of cerebrovascular disease (CeVD) that predicts accelerated cognitive decline. Presence of CMIs is known to be associated with global cortical atrophy, although the mechanism linking the two is unclear. Our primary objective was to examine the relation between CMIs and cortical atrophy and to establish possible perilesional atrophy surrounding CMIs. Our secondary objective was to examine the role of cortical atrophy in CMI-associated cognitive impairment.
Methods:
Patients were recruited from 2 Singapore memory clinics between December 2010 and September 2013 and included if they received the diagnosis no objective cognitive impairment, cognitive impairment (with or without a history of stroke), or Alzheimer or vascular dementia. Cortical thickness, chronic CMIs, and MRI markers of CeVD were assessed on 3T MRI. Patients underwent cognitive testing. Cortical thickness was compared globally between patients with and without CMIs, regionally within individual patients with CMIs comparing brain regions with CMIs to the corresponding contralateral region without CMIs, and locally within individuals patients in a 50-mm radius of CMIs. Global cortical thickness was analyzed as mediator in the relation between CMI and cognitive performance.
Results:
Of the 238 patients (mean age 72.5 years, SD 9.1 years) enrolled, 75 had ≥1 CMIs. Patient with CMIs had a 2.1% lower global cortical thickness (B = -0.049 mm, 95% confidence interval [CI] 0.091 to -0.007, p = 0.022) compared to patients without CMIs, after correction for age, sex, education, and intracranial volume. In patients with CMIs, cortical thickness in brain regions with CMIs was 2.2% lower than in contralateral regions without CMIs (B = -0.048 mm [95% CI -0.071 to -0.026], p < 0.001). In a 20-mm radius area surrounding the CMI core, cortical thickness was lower than in the area 20 to 50 mm from the CMI core (mean difference -0.06 mm [-0.10 to -0.02], p = 0.002). Global cortical thickness was a significant mediator in the relationship between CMI presence and cognitive performance as measure with the Mini-Mental State Examination (B = -0.12 [-0.22 to -0.01], p = 0.025).
Discussion:
We found cortical atrophy surrounding CMIs, suggesting a perilesional effect in a cortical area many times larger than the CMI core. Our findings support the notion that CMIs affect brain structure beyond the actual lesion site.
Insights
Cerebral cortical microinfarcts (CMIs) are linked to reduced brain thickness and cognitive decline. This study reveals atrophy surrounding CMIs, indicating a broader impact on brain structure beyond the lesion itself.
Area of Science:
- Neurology
- Neuroimaging
- Cerebrovascular Disease Research
Background:
- Cerebral cortical microinfarcts (CMIs) are emerging MRI markers for cerebrovascular disease (CeVD).
- CMIs predict accelerated cognitive decline and are associated with global cortical atrophy.
- The precise relationship and mechanisms between CMIs and cortical atrophy remain unclear.
Purpose of the Study:
- To investigate the association between CMIs and cortical atrophy.
- To determine if atrophy occurs in the vicinity of CMIs (perilesional atrophy).
- To assess the role of cortical atrophy in cognitive impairment linked to CMIs.
Main Methods:
- Recruited patients from memory clinics with diagnoses ranging from no cognitive impairment to dementia.
- Utilized 3T MRI to assess cortical thickness, CMIs, and other CeVD markers.
- Compared cortical thickness globally, regionally (CMI vs. contralateral), and locally around CMIs; analyzed cognitive performance and mediation by cortical thickness.
Main Results:
- Patients with CMIs exhibited significantly lower global cortical thickness (2.1%) compared to those without.
- Cortical thickness was reduced by 2.2% in brain regions with CMIs versus contralateral regions.
- A significant reduction in cortical thickness was observed within a 20-mm radius around CMIs.
- Global cortical thickness mediated the relationship between CMI presence and cognitive performance (MMSE).
Conclusions:
- Cortical atrophy is present in areas surrounding CMIs, suggesting a perilesional effect.
- CMIs impact brain structure in regions extending beyond the immediate lesion site.
- These findings highlight the structural consequences of CMIs on the brain and their link to cognitive function.
