Publication
The role of small diffusion-weighted imaging lesions in cerebral small vessel disease.
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Date:
17-09-2019
DOI:
10.1212/WNL.0000000000008364
Abstract: To investigate the prevalence of asymptomatic diffusion-weighted imaging–positive (DWI+) lesions in in iduals with cerebral small vessel disease (SVD) and identify their role in the origin of SVD markers on MRI. We included 503 in iduals with SVD from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort (RUN DMC) study (mean age 65.6 years [SD 8.8], 56.5% male) with 1.5T MRI in 2006 and, if available, follow-up MRI in 2011 and 2015. We screened DWI scans (n = 1,152) for DWI+ lesions, assessed lesion evolution on follow-up fluid-attenuated inversion recovery, T1 and T2* images, and examined the association between DWI+ lesions and annual SVD progression (white matter hyperintensities [WMH], lacunes, microbleeds). We found 50 DWI+ lesions in 39 in iduals on 1,152 DWI (3.4%). In iduals with DWI+ lesions were older ( p = 0.025), more frequently had a history of hypertension ( p = 0.021), and had a larger burden of preexisting SVD MRI markers (WMH, lacunes, microbleeds: all p 0.001) compared to in iduals without DWI+ lesions. Of the 23 DWI+ lesions with available follow-up MRI, 14 (61%) evolved into a WMH, 8 (35%) resulted in a cavity, and 1 (4%) was no longer visible. Presence of DWI+ lesions was significantly associated with annual WMH volume increase and yearly incidence of lacunes and microbleeds (all p 0.001). Over 3% of in iduals with SVD have DWI+ lesions. Although DWI+ lesions play a role in the progression of SVD, they may not fully explain progression of SVD markers on MRI, suggesting that other factors than acute ischemia are at play.