Estimating Total Cerebral Microinfarct Burden From Diffusion-Weighted Imaging

Eitan Auriel; M. Brandon Westover; Matt T. Bianchi; Yael Reijmer; Sergi Martinez-Ramirez; Jun Ni; Ellis Van Etten; Matthew P. Frosch; Panagiotis Fotiadis; Kris Schwab; Anastasia Vashkevich; Grégoire Boulouis; Alayna P. Younger; Keith A. Johnson; Reisa A. Sperling; Trey Hedden; M. Edip Gurol; Anand Viswanathan; Steven M. Greenberg

doi:10.1161/STROKEAHA.115.009208

Estimating Total Cerebral Microinfarct Burden From Diffusion-Weighted Imaging

Eitan Auriel, M. Brandon Westover, Matt T. Bianchi, Yael Reijmer, Sergi Martinez-Ramirez, Jun Ni, Ellis Van Etten, Matthew P. Frosch, Panagiotis Fotiadis, Kris Schwab, Anastasia Vashkevich, Grégoire Boulouis, Alayna P. Younger, Keith A. Johnson, Reisa A. Sperling, Trey Hedden, M. Edip Gurol, Anand Viswanathan, Steven M. Greenberg

Research output: Contribution to journal › Article › peer-review

58 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	2129-2135
Number of pages	7
Journal	Stroke
Volume	46
Issue number	8
DOIs	https://doi.org/10.1161/STROKEAHA.115.009208
State	Published - 1 Aug 2015
Externally published	Yes

Keywords

brain
cerebral hemorrhage
cerebral infarction
diffusion magnetic resonance imaging
mild cognitive impairment

Access to Document

10.1161/STROKEAHA.115.009208

Cite this

Auriel, E., Westover, M. B., Bianchi, M. T., Reijmer, Y., Martinez-Ramirez, S., Ni, J., Van Etten, E., Frosch, M. P., Fotiadis, P., Schwab, K., Vashkevich, A., Boulouis, G., Younger, A. P., Johnson, K. A., Sperling, R. A., Hedden, T., Gurol, M. E., Viswanathan, A., & Greenberg, S. M. (2015). Estimating Total Cerebral Microinfarct Burden From Diffusion-Weighted Imaging. Stroke, 46(8), 2129-2135. https://doi.org/10.1161/STROKEAHA.115.009208

@article{3dd7f89a0f3f4c449edcb16d65d126b5,

title = "Estimating Total Cerebral Microinfarct Burden From Diffusion-Weighted Imaging",

abstract = "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.",

keywords = "brain, cerebral hemorrhage, cerebral infarction, diffusion magnetic resonance imaging, mild cognitive impairment",

author = "Eitan Auriel and Westover, {M. Brandon} and Bianchi, {Matt T.} and Yael Reijmer and Sergi Martinez-Ramirez and Jun Ni and {Van Etten}, Ellis and Frosch, {Matthew P.} and Panagiotis Fotiadis and Kris Schwab and Anastasia Vashkevich and Gr{\'e}goire Boulouis and Younger, {Alayna P.} and Johnson, {Keith A.} and Sperling, {Reisa A.} and Trey Hedden and Gurol, {M. Edip} and Anand Viswanathan and Greenberg, {Steven M.}",

note = "Publisher Copyright: {\textcopyright} 2015 American Heart Association, Inc.",

year = "2015",

month = aug,

day = "1",

doi = "10.1161/STROKEAHA.115.009208",

language = "English",

volume = "46",

pages = "2129--2135",

journal = "Stroke",

issn = "0039-2499",

publisher = "Wolters Kluwer Health",

number = "8",

}

Auriel, E, Westover, MB, Bianchi, MT, Reijmer, Y, Martinez-Ramirez, S, Ni, J, Van Etten, E, Frosch, MP, Fotiadis, P, Schwab, K, Vashkevich, A, Boulouis, G, Younger, AP, Johnson, KA, Sperling, RA, Hedden, T, Gurol, ME, Viswanathan, A & Greenberg, SM 2015, 'Estimating Total Cerebral Microinfarct Burden From Diffusion-Weighted Imaging', Stroke, vol. 46, no. 8, pp. 2129-2135. https://doi.org/10.1161/STROKEAHA.115.009208

TY - JOUR

T1 - Estimating Total Cerebral Microinfarct Burden From Diffusion-Weighted Imaging

AU - Auriel, Eitan

AU - Westover, M. Brandon

AU - Bianchi, Matt T.

AU - Reijmer, Yael

AU - Martinez-Ramirez, Sergi

AU - Ni, Jun

AU - Van Etten, Ellis

AU - Frosch, Matthew P.

AU - Fotiadis, Panagiotis

AU - Schwab, Kris

AU - Vashkevich, Anastasia

AU - Boulouis, Grégoire

AU - Younger, Alayna P.

AU - Johnson, Keith A.

AU - Sperling, Reisa A.

AU - Hedden, Trey

AU - Gurol, M. Edip

AU - Viswanathan, Anand

AU - Greenberg, Steven M.

PY - 2015/8/1

Y1 - 2015/8/1

N2 - 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.

AB - 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.

KW - brain

KW - cerebral hemorrhage

KW - cerebral infarction

KW - diffusion magnetic resonance imaging

KW - mild cognitive impairment

UR - http://www.scopus.com/inward/record.url?scp=85015028362&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.115.009208

DO - 10.1161/STROKEAHA.115.009208

M3 - Article

C2 - 26159796

AN - SCOPUS:85015028362

SN - 0039-2499

VL - 46

SP - 2129

EP - 2135

JO - Stroke

JF - Stroke

IS - 8

ER -

Estimating Total Cerebral Microinfarct Burden From Diffusion-Weighted Imaging

Abstract

Keywords

Access to Document

Fingerprint

Cite this