Estimating Total Cerebral Microinfarct Burden From Diffusion-Weighted Imaging

被引：66

作者：

Auriel, Eitan ^{[1
]}

Westover, M. Brandon ^{[1
]}

Bianchi, Matt T. ^{[1
]}

Reijmer, Yael ^{[1
]}

Martinez-Ramirez, Sergi ^{[1
]}

Ni, Jun ^{[1
]}

Van Etten, Ellis ^{[1
]}

Frosch, Matthew P. ^{[2
]}

Fotiadis, Panagiotis ^{[1
]}

Schwab, Kris ^{[1
]}

Vashkevich, Anastasia ^{[1
]}

Boulouis, Gregoire ^{[1
]}

Younger, Alayna P. ^{[3
]}

Johnson, Keith A. ^{[3
]}

Sperling, Reisa A. ^{[3
,4
]}

Hedden, Trey ^{[3
]}

Gurol, M. Edip ^{[1
]}

Viswanathan, Anand ^{[1
]}

Greenberg, Steven M. ^{[1
]}

机构：

[1] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Neurol,J Philip Kistler Stroke Res Ctr, Boston, MA USA

[2] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Pathol,Neuropathol Serv,CS Kubik Lab Neuropa, Boston, MA USA

[3] Massachusetts Gen Hosp, Dept Radiol, Athinoula A Martinos Ctr Biomed Imaging, Charlestown, MA USA

[4] Harvard Univ, Brigham & Womens Hosp, Sch Med, Dept Neurol,Ctr Alzheimer Res & Treatment, Boston, MA 02115 USA

来源：

STROKE | 2015年 / 46卷 / 08期

基金：

美国国家卫生研究院;

关键词：

brain; cerebral hemorrhage; cerebral infarction; diffusion magnetic resonance imaging; mild cognitive impairment; INTRACEREBRAL HEMORRHAGE; CORTICAL MICROINFARCTS; AMYLOID ANGIOPATHY; ACUTE INFARCTS; ACUTE STROKE; DEMENTIA; LESIONS; MRI; DISEASE; SILENT;

D O I：

10.1161/STROKEAHA.115.009208

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

100204 [神经病学];

摘要：

Background and Purpose-Cerebral microinfarcts (CMI) are important contributors to vascular cognitive impairment. Magnetic resonance imaging diffusion-weighted imaging (DWI) hyperintensities have been suggested to represent acute CMI. We aim to describe a mathematical method for estimating total number of CMI based on the presence of incidental DWI lesions. Methods-We reviewed magnetic resonance imaging scans of subjects with cognitive decline, cognitively normal subjects and previously reported subjects with past intracerebral hemorrhage (ICH). Based on temporal and spatial characteristics of DWI lesions, we estimated the annual rate of CMI needed to explain the observed rate of DWI lesion detection in each group. To confirm our estimates, we performed extensive sampling for CMI in the brain of a deceased subject with past lobar ICH who found to have a DWI lesion during life. Results-Clinically silent DWI lesions were present in 13 of 343 (3.8%) cognitively impaired and 10 of 199 (5%) cognitively intact normal non-ICH patients, both lower than the incidence in the past ICH patients (23 of 178; 12.9%; P<0.0006). The predicted annual incidence of CMI ranges from 16 to 1566 for non-ICH and 50 to 5041 for ICH individuals. Histological sampling revealed a total of 60 lesions in 32 sections. Based on previously reported methods, this density of CMI yields an estimated total brain burden maximum likelihood estimate of 9321 CMIs (95% confidence interval, 7255-11 990). Conclusions-Detecting even a single DWI lesion suggests an annual incidence of hundreds of new CMI. The cumulative effects of these lesions may directly contribute to small-vessel-related vascular cognitive impairment.

引用

页码：2129 / 2135

页数：7

共 33 条

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