Predictors of Lesion Cavitation After Recent Small Subcortical Stroke.

T Gattringer, Hernandez M Valdes, A Heye, PA Armitage, S Makin, F Chappell, D Pinter, F Doubal, C Enzinger, F Fazekas, JM Wardlaw

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Morphologic evolution of recent small subcortical infarcts (RSSI) ranges from lesion disappearance to lacune formation and the reasons for this variability are still poorly understood. We hypothesized that diffusion tensor imaging (DTI) and blood-brain-barrier (BBB) abnormalities early on can predict tissue damage 1 year after an RSSI. We studied prospectively recruited patients with a symptomatic MRI-defined RSSI who underwent baseline and two pre-specified MRI examinations at 1–3-month and 1-year post-stroke. We defined the extent of long-term tissue destruction, termed cavitation index, as the ratio of the 1-year T1-weighted cavity volume to the baseline RSSI volume on FLAIR. We calculated fractional anisotropy and mean diffusivity (MD) of the RSSI and normal-appearing white matter, and BBB leakage in different tissues on dynamic contrast-enhanced MRI. Amongst 60 patients, at 1-year post-stroke, 44 patients showed some degree of RSSI cavitation on FLAIR, increasing to 50 on T2- and 56 on T1-weighted high-resolution scans, with a median cavitation index of 7% (range, 1–36%). Demographic, clinical, and cerebral small vessel disease features were not associated with the cavitation index. While lower baseline MD of the RSSI (rs = − 0.371; p = 0.004) and more contrast leakage into CSF (rs = 0.347; p = 0.007) were associated with the cavitation index in univariable analysis, only BBB leakage in CSF remained independently associated with cavitation (beta = 0.315, p = 0.046). Increased BBB leakage into CSF may indicate worse endothelial dysfunction and increased risk of tissue destruction post RSSI. Although cavitation was common, it only affected a small proportion of the original RSSI.

Original languageEnglish
Pages (from-to)402-411
Number of pages10
JournalTranslational Stroke Research
Early online date8 Nov 2019
Publication statusPublished - Jun 2020

Bibliographical note

The Wellcome Trust (WT088134/Z/09/A) and Row Fogo Charitable Trust funded the Mild Stroke Study 2 from which the patients were selected. We thank the European Union Horizon 2020, PHC-03-15, project no. 666881, ‘SVDs@Target’, the Fondation Leducq Transatlantic Network of Excellence for the Study of Perivascular Spaces in Small Vessel Disease, ref. no. 16 CVD 05, and the MRC UK Dementia Research Institute for support.


  • lacunar stroke
  • recent small subcortical infarction
  • MRI
  • blood-brain barrier
  • diffusion tensor imaging
  • Blood-brain barrier
  • Lacunar stroke
  • Recent small subcortical infarction
  • Diffusion tensor imaging


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