Assessing cortical cerebral microinfarcts on iron-sensitive MRI in cerebral small vessel disease. Issue 12 (December 2021)

• Record Type: Journal Article
• Authors: Wiegertjes, Kim; Chan, Kwok-Shing; Telgte, Annemieke ter; Gesierich, Benno; Norris, David G; Klijn, Catharina JM; Duering, Marco; Tuladhar, Anil M; Marques, José P; Leeuw, Frank-Erik de
• Is Part Of: Journal of cerebral blood flow & metabolism. Volume 41:Issue 12(2021)
• Page Start: 3391
• Page End: 3399
• Publication Date: 2021-12
• Subjects: Acute ischemia -- cerebrovascular disease -- cortical microinfarcts -- magnetic resonance imaging -- small vessel disease; Cerebral circulation -- Periodicals; Brain -- Metabolism -- Periodicals; Brain -- Blood-vessels -- Periodicals; Cerebrovascular disease -- Periodicals; 612.824
• DOI: 10.1177/0271678X211039609
• Languages: English
• ISSNs: 0271-678X

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.