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[Diagnosis of silent cerebral infarction]
1Department of Neurology, School of Medicine, Keio University.
Abstract:
High intensity lesions are frequently encountered in the basal ganglia, thalamus and cerebral white matter in T2-weighted images of MRI. Most of them are generally assumed to represent cerebral infarction without pathologic verification. Studies were performed on the brain showing such lesions with particular emphasis on the differential diagnosis of lacunar infarcts and dilated perivascular spaces. As a result, it was shown that irregularly shaped, lesions or those in the thalamus more frequently represent lacunar infarcts, while those with smooth rims or in the putamen likely represent dilated perivascular spaces. Neither proton density nor the size of the lesions on the MRI helps to differentiate the two conditions. Small patchy high intensity areas of the white matter in the T2-weighted images showed myelin pallor with mild gliosis. Periventricular "rims" of high intensity revealed only subependymal gliosis.
Insights
High intensity lesions in MRI scans can be either lacunar infarcts or dilated perivascular spaces. Irregularly shaped lesions, especially in the thalamus, suggest infarcts, while smooth-rimmed lesions in the putamen indicate dilated perivascular spaces.
Area of Science:
- Neurology
- Radiology
- Pathology
Context:
- High-intensity lesions in the basal ganglia, thalamus, and cerebral white matter are common findings on T2-weighted MRI scans.
- These lesions are often presumed to be cerebral infarctions without pathological confirmation.
- Distinguishing between lacunar infarcts and dilated perivascular spaces is crucial for accurate diagnosis.
Purpose:
- To differentiate between lacunar infarcts and dilated perivascular spaces based on MRI characteristics.
- To investigate the pathological basis of high-intensity white matter lesions observed on MRI.
Summary:
- Irregularly shaped lesions or those located in the thalamus are more indicative of lacunar infarcts.
- Lesions with smooth rims or situated in the putamen are more likely to represent dilated perivascular spaces.
- Neither lesion size nor proton density on MRI effectively differentiates between these two conditions.
- Small, patchy high-intensity white matter lesions correlate with myelin pallor and mild gliosis.
- Periventricular high-intensity "rims" are associated with subependymal gliosis.
Impact:
- Provides imaging criteria to help differentiate lacunar infarcts from dilated perivascular spaces.
- Clarifies the neuropathological correlates of various high-intensity lesions in the brain white matter.
- Aids clinicians in more accurate diagnosis and management of basal ganglia and thalamic lesions identified on MRI.