Assessing cortical cerebral microinfarcts on iron-sensitive MRI in cerebral small vessel disease

Kim Wiegertjes, Kwok Shing Chan, Annemieke ter Telgte, Benno Gesierich, David G. Norris, Catharina J.M. Klijn, Marco Duering, Anil M. Tuladhar, José P. Marques, Frank-Erik de Leeuw*

*Corresponding author for this work

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Abstract

Recent studies suggest that a subset of cortical microinfarcts may be identifiable on T2* but invisible on T1 and T2 follow-up images. We aimed to investigate whether cortical microinfarcts are associated with iron accumulation after the acute stage. The RUN DMC – InTENse study is a serial MRI study including individuals with cerebral small vessel disease (SVD). 54 Participants underwent 10 monthly 3 T MRIs, including diffusion-weighted imaging, quantitative R1 (=1/T1), R2 (=1/T2), and R2* (=1/T2*) mapping, from which MRI parameters within areas corresponding to microinfarcts and control region of interests (ROIs) were retrieved within 16 participants. Finally, we compared pre- and post-lesional values with repeated measures ANOVA and post-hoc paired t-tests using the mean difference between lesion and control ROI values. We observed 21 acute cortical microinfarcts in 7 of the 54 participants (median age 69 years [IQR 66–74], 63% male). R2* maps demonstrated an increase in R2* values at the moment of the last available follow-up MRI (median [IQR], 5 [5–14] weeks after infarction) relative to prelesional values (p =.08), indicative of iron accumulation. Our data suggest that cortical microinfarcts are associated with increased R2* values, indicative of iron accumulation, possibly due to microhemorrhages, neuroinflammation or neurodegeneration, awaiting histopathological verification.

Original languageEnglish
JournalJournal of Cerebral Blood Flow and Metabolism
DOIs
Publication statusE-pub ahead of print/First online - 20 Aug 2021

Keywords

  • Acute ischemia
  • cerebrovascular disease
  • cortical microinfarcts
  • magnetic resonance imaging
  • small vessel disease

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