Long-term morphological changes of symptomatic lacunar infarcts and surrounding white matter on structural magnetic resonance imaging

Caroline M.J. Loos; Stephen D.J. Makin; Julie Staals; Martin S. Dennis; Robert J. Van Oostenbrugge; Joanna M. Wardlaw

doi:10.1161/STROKEAHA.117.020495

Long-term morphological changes of symptomatic lacunar infarcts and surrounding white matter on structural magnetic resonance imaging

Caroline M.J. Loos
, Stephen D.J. Makin
, Julie Staals
, Martin S. Dennis
, Robert J. Van Oostenbrugge
, Joanna M. Wardlaw^*

^*Corresponding author for this work

Applied Health Sciences

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

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Abstract

Background and Purpose-Insights into evolution of cerebral small vessel disease on neuroimaging might advance knowledge of the natural disease course. Data on evolution of sporadic symptomatic lacunar infarcts are limited. We investigated long-term changes of symptomatic lacunar infarcts and surrounding white matter on structural magnetic resonance imaging. Methods-From 2 nonoverlapping, single-center, prospective observational stroke studies, we selected patients presenting with lacunar stroke symptoms with a recent small subcortical (lacunar) infarct on baseline structural magnetic resonance imaging and with follow-up magnetic resonance imaging available at 1 to 5 years. We assessed changes in imaging characteristics of symptomatic lacunar infarcts and surrounding white matter. Results-We included 79 patients of whom 32 (41%) had complete and 40 (51%) had partial cavitation of the index lesion at median follow-up of 403 (range, 315-1781) days. In 42 of 79 (53%) patients, we observed a new white matter hyperintensity adjacent to the index infarct, either superior (white matter hyperintensity cap, n=17), inferior (white matter hyperintensity track, n=13), or both (n=12). Conclusions-Half of the sporadic symptomatic lacunar infarcts developed secondary changes in superior and inferior white matter. These white matter hyperintensity caps and tracks may reflect another aspect of cerebral small vesselrelated disease progression. The clinical and prognostic values remain to be determined.

Original language	English
Pages (from-to)	1183-1188
Number of pages	6
Journal	Stroke
Volume	49
Issue number	5
Early online date	22 Mar 2018
DOIs	https://doi.org/10.1161/STROKEAHA.117.020495
Publication status	Published - May 2018

Bibliographical note

The contributing studies were funded by the Chief Scientist Office of the Scottish Executive (grant 217 NTU R37933), the Wellcome Trust (grants 075611 and WT088134/Z/09/A), and Row Fogo Charitable Trust. The imaging was performed at the Brain Research Imaging Centre Edinburgh, which is supported by the SINAPSE (Scottish Imaging Network, A Platform for Scientific Excellence) collaboration and the Chief Scientist Office of the Scottish Government (http://www.bric.ed.ac.uk/). This work was supported by European Union Horizon 2020 (EU H2020), PHC- 03 to 15, project No. 666881, SVDs@Target, and the Fondation Leducq Transatlantic Network of Excellence for Study of Perivascular Spaces in Small Vessel Disease, ref No. 16 CVD 05. Dr Loos was supported by the Dutch Alzheimer Foundation.

Funding

Received December 14, 2017; final revision received January 30, 2018; accepted February 15, 2018. From the Cardiovascular Research Institute Maastricht (C.M.J.L., J.S., R.J.v.O.) and Department of Neurology (C.M.J.L., J.S., R.J.v.O.), Maastricht University Medical Centre, Maastricht University, the Netherlands; Brain Research Imaging Centre, Neuroimaging Sciences, Centre for Clinical Brain Sciences (S.D.J.M., M.S.D., J.M.W.) and UK Dementia Research Institute (J.M.W.), University of Edinburgh, Scotland, United Kingdom; Scottish Imaging Network, A Platform for Scientific Excellence Collaboration, Scotland, United Kingdom (J.M.W.); and Department of Neurology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium (C.M.J.L.). This work reflects the views of the authors and not of the funders. The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl/doi:10.1161/STROKEAHA. 117.020495/-/DC1. Correspondence to Joanna M. Wardlaw, MD, FMedSci, Centre for Clinical Brain Sciences, University of Edinburgh, FU303e Chancellor’s Bldg, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom. E-mail [email protected] © 2018 The Authors. Stroke is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited. The contributing studies were funded by the Chief Scientist Office of the Scottish Executive (grant 217 NTU R37933), the Wellcome Trust (grants 075611 and WT088134/Z/09/A), and Row Fogo Charitable Trust. The imaging was performed at the Brain Research Imaging Centre Edinburgh, which is supported by the SINAPSE (Scottish Imaging Network, A Platform for Scientific Excellence) collaboration and the Chief Scientist Office of the Scottish Government (http://www.bric.ed.ac.uk/). This work was supported by European Union Horizon 2020 (EU H2020), PHC-03 to 15, project No. 666881, SVDs@Target, and the Fondation Leducq Transatlantic Network of Excellence for Study of Perivascular Spaces in Small Vessel Disease, ref No. 16 CVD 05. Dr Loos was supported by the Dutch Alzheimer Foundation.

Keywords

Cerebral small vessel diseases
Follow-up studies
Lacunar
Stroke
Wallerian degeneration

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Cite this

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title = "Long-term morphological changes of symptomatic lacunar infarcts and surrounding white matter on structural magnetic resonance imaging",

abstract = "Background and Purpose-Insights into evolution of cerebral small vessel disease on neuroimaging might advance knowledge of the natural disease course. Data on evolution of sporadic symptomatic lacunar infarcts are limited. We investigated long-term changes of symptomatic lacunar infarcts and surrounding white matter on structural magnetic resonance imaging. Methods-From 2 nonoverlapping, single-center, prospective observational stroke studies, we selected patients presenting with lacunar stroke symptoms with a recent small subcortical (lacunar) infarct on baseline structural magnetic resonance imaging and with follow-up magnetic resonance imaging available at 1 to 5 years. We assessed changes in imaging characteristics of symptomatic lacunar infarcts and surrounding white matter. Results-We included 79 patients of whom 32 (41\%) had complete and 40 (51\%) had partial cavitation of the index lesion at median follow-up of 403 (range, 315-1781) days. In 42 of 79 (53\%) patients, we observed a new white matter hyperintensity adjacent to the index infarct, either superior (white matter hyperintensity cap, n=17), inferior (white matter hyperintensity track, n=13), or both (n=12). Conclusions-Half of the sporadic symptomatic lacunar infarcts developed secondary changes in superior and inferior white matter. These white matter hyperintensity caps and tracks may reflect another aspect of cerebral small vesselrelated disease progression. The clinical and prognostic values remain to be determined.",

keywords = "Cerebral small vessel diseases, Follow-up studies, Lacunar, Stroke, Wallerian degeneration",

author = "Loos, \{Caroline M.J.\} and Makin, \{Stephen D.J.\} and Julie Staals and Dennis, \{Martin S.\} and \{Van Oostenbrugge\}, \{Robert J.\} and Wardlaw, \{Joanna M.\}",

note = "The contributing studies were funded by the Chief Scientist Office of the Scottish Executive (grant 217 NTU R37933), the Wellcome Trust (grants 075611 and WT088134/Z/09/A), and Row Fogo Charitable Trust. The imaging was performed at the Brain Research Imaging Centre Edinburgh, which is supported by the SINAPSE (Scottish Imaging Network, A Platform for Scientific Excellence) collaboration and the Chief Scientist Office of the Scottish Government (http://www.bric.ed.ac.uk/). This work was supported by European Union Horizon 2020 (EU H2020), PHC- 03 to 15, project No. 666881, SVDs@Target, and the Fondation Leducq Transatlantic Network of Excellence for Study of Perivascular Spaces in Small Vessel Disease, ref No. 16 CVD 05. Dr Loos was supported by the Dutch Alzheimer Foundation.",

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doi = "10.1161/STROKEAHA.117.020495",

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AU - Makin, Stephen D.J.

AU - Staals, Julie

AU - Dennis, Martin S.

AU - Van Oostenbrugge, Robert J.

AU - Wardlaw, Joanna M.

N1 - The contributing studies were funded by the Chief Scientist Office of the Scottish Executive (grant 217 NTU R37933), the Wellcome Trust (grants 075611 and WT088134/Z/09/A), and Row Fogo Charitable Trust. The imaging was performed at the Brain Research Imaging Centre Edinburgh, which is supported by the SINAPSE (Scottish Imaging Network, A Platform for Scientific Excellence) collaboration and the Chief Scientist Office of the Scottish Government (http://www.bric.ed.ac.uk/). This work was supported by European Union Horizon 2020 (EU H2020), PHC- 03 to 15, project No. 666881, SVDs@Target, and the Fondation Leducq Transatlantic Network of Excellence for Study of Perivascular Spaces in Small Vessel Disease, ref No. 16 CVD 05. Dr Loos was supported by the Dutch Alzheimer Foundation.

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N2 - Background and Purpose-Insights into evolution of cerebral small vessel disease on neuroimaging might advance knowledge of the natural disease course. Data on evolution of sporadic symptomatic lacunar infarcts are limited. We investigated long-term changes of symptomatic lacunar infarcts and surrounding white matter on structural magnetic resonance imaging. Methods-From 2 nonoverlapping, single-center, prospective observational stroke studies, we selected patients presenting with lacunar stroke symptoms with a recent small subcortical (lacunar) infarct on baseline structural magnetic resonance imaging and with follow-up magnetic resonance imaging available at 1 to 5 years. We assessed changes in imaging characteristics of symptomatic lacunar infarcts and surrounding white matter. Results-We included 79 patients of whom 32 (41%) had complete and 40 (51%) had partial cavitation of the index lesion at median follow-up of 403 (range, 315-1781) days. In 42 of 79 (53%) patients, we observed a new white matter hyperintensity adjacent to the index infarct, either superior (white matter hyperintensity cap, n=17), inferior (white matter hyperintensity track, n=13), or both (n=12). Conclusions-Half of the sporadic symptomatic lacunar infarcts developed secondary changes in superior and inferior white matter. These white matter hyperintensity caps and tracks may reflect another aspect of cerebral small vesselrelated disease progression. The clinical and prognostic values remain to be determined.

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Long-term morphological changes of symptomatic lacunar infarcts and surrounding white matter on structural magnetic resonance imaging

Abstract

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Stephen Makin

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Long-term morphological changes of symptomatic lacunar infarcts and surrounding white matter on structural magnetic resonance imaging

Abstract

Bibliographical note

Funding

Keywords

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Stephen Makin

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