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White-matter lesions in MR imaging of clinically healthy brains of elderly subjects: possible pathologic basis
Abstract:
Patchy white-matter lesions occur in the magnetic resonance (MR) imaging brain studies of 20%-30% of neurologically healthy elderly subjects. To determine the frequency of histologically verifiable white-matter lesions at autopsy in such subjects the authors examined serial, microscopic, whole brain sections from 15 clinically healthy subjects aged 52-72 years. Small white-matter lesions were found in 12. In these 12, zones of atrophic perivascular demyelination were present in eight brains. These are not the familiar thrombotic, embolic, or ischemic vascular lesions that produce acute necrosis. This mild vascular insufficiency produces atrophy, which has been recognized in the pathology literature but whose clinical significance remains unknown. Other lesions seen were small vascular malformations in the centrum ovale in four brains, diverticula of the lateral ventricle extending into the white matter in three, and an isolated central white-matter infarction in one. All of these lesions are probably the basis of the patchy white-matter lesions seen on MR imaging studies in the neurologically healthy elderly population.
Insights
Histological examination of healthy elderly brains revealed white-matter lesions in most subjects. These findings explain patchy lesions often seen on magnetic resonance imaging (MRI) in older adults.
Area of Science:
- Neuropathology
- Neuroimaging
- Geriatric Medicine
Background:
- Patchy white-matter lesions are common in magnetic resonance (MR) imaging of healthy elderly individuals (20-30%).
- The histological basis for these MR imaging findings in the absence of neurological disease is not well understood.
Purpose of the Study:
- To determine the frequency of histologically verifiable white-matter lesions at autopsy in clinically healthy elderly subjects.
- To correlate autopsy findings with common MR imaging observations.
Main Methods:
- Serial, microscopic examination of whole brain sections.
- Analysis of brains from 15 clinically healthy subjects aged 52-72 years.
Main Results:
- Small white-matter lesions were identified in 12 out of 15 subjects.
- Atrophic perivascular demyelination was present in 8 brains, attributed to mild vascular insufficiency.
- Other findings included vascular malformations, lateral ventricle diverticula, and a white-matter infarction.
Conclusions:
- The observed histological lesions likely account for the patchy white-matter lesions seen on MR imaging in the healthy elderly population.
- The clinical significance of mild vascular insufficiency-induced atrophy requires further investigation.