, Volume 50, Issue 9, pp 753–758 | Cite as

Discriminating between silent cerebral infarction and deep white matter hyperintensity using combinations of three types of magnetic resonance images: a multicenter observer performance study

  • Makoto SasakiEmail author
  • Toshinori Hirai
  • Toshiaki Taoka
  • Shuichi Higano
  • Chieko Wakabayashi
  • Eiji Matsusue
  • Masahiro Ida
Diagnostic Neuroradiology



We attempted to determine the most appropriate combination of magnetic resonance (MR) images that can accurately detect and discriminate between asymptomatic infarction and deep white matter hyperintensity (DWMH); these lesions have different clinical implications and are occasionally confused.

Materials and methods

We performed an observer performance analysis using cerebral MR images of 45 individuals with or without asymptomatic small white matter infarction and/or mild DWMH who participated in a physical checkup program at four institutions. Six observers interpreted whether infarction and/or DWMH existed in combinations of two or three image types of the T1-weighted images (T1WI), T2-weighted images (T2WI), and fluid-attenuated inversion recovery (FLAIR) images. The observers’ performance was evaluated with a receiver operating characteristic (ROC) analysis.


The averaged area under the ROC curve (Az) for detecting a infarction was significantly larger in the combination of all the three image types (0.95) than that in any combinations of the two image types (T1WI and FLAIR images, 0.87; T2WI and FLAIR images, 0.85; T1WI and T2WI, 0.86). The Az for detecting DWMH was significantly smaller in the combination of T1WI and T2WI (0.79) than that in other image combinations (T1WI and FLAIR, 0.89; T2WI and FLAIR, 0.91; T1WI, T2WI, and FLAIR, 0.90).


The combination of T1WI, T2WI, and FLAIR images is required to accurately detect both small white matter infarction and mild DWMH.


Asymptomatic cerebral infarction Deep white matter hyperintensity Magnetic resonance imaging Receiver operating characteristic analysis 



Authors were grateful to Prof. Shigehiko Katsuragawa, Department of Radiological Technology, School of Health Sciences, Kumamoto University, for his generous help with the statistical analyses. This work was partly supported by a Grant for Leading Projects from the Japanese Society for Magnetic Resonance in Medicine and by a Grant-in-Aid for Science Research (18390256) and a Grant-in-Aid for Advanced Medical Science Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

Conflict of interest statement

We declare that we have no conflict of interest.


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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Makoto Sasaki
    • 1
    Email author
  • Toshinori Hirai
    • 2
  • Toshiaki Taoka
    • 3
  • Shuichi Higano
    • 4
  • Chieko Wakabayashi
    • 5
  • Eiji Matsusue
    • 6
  • Masahiro Ida
    • 7
  1. 1.Advanced Medical Research CenterIwate Medical UniversityMoriokaJapan
  2. 2.Department of Diagnostic Radiology, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
  3. 3.Department of RadiologyNara Prefectural Medical UniversityKashiharaJapan
  4. 4.Department of Diagnostic RadiologyTohoku University School of MedicineSendaiJapan
  5. 5.Department of RadiologySuiseikai Kajikawa HospitalHiroshimaJapan
  6. 6.Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of MedicineTottori UniversityYonagoJapan
  7. 7.Department of RadiologyEbara HospitalTokyoJapan

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