Journal of Neurology

, Volume 266, Issue 3, pp 766–772 | Cite as

Evolution of acute lacunar lesions in terms of size and shape: a PICASSO sub-study

  • Hyuk Sung Kwon
  • A-Hyun Cho
  • Min Hwan Lee
  • Dongwhane Lee
  • Da-Eun Jeong
  • Changwoon Choi
  • Ji-wan Jang
  • Sungwook Yu
  • Jong-Ho Park
  • Sung Hyuk Heo
  • Ji-Sung Lee
  • Sun U. KwonEmail author
  • PICASSO investigators
Original Communication


The imaging definition of lacunar infarcts is variable, particularly regarding their size and the presence of cavitation. We investigated the changes of diameter and evolution pattern of acute lacunar infarcts, and the factors associated with the evolution pattern. Patients with acute single subcortical hemispheric or brainstem ischemic lesions of penetrating arterial territories were included. Maximal diameters on initial diffusion-weighted image (DWI) and follow-up fluid-attenuated inversion recovery image (FLAIR), which performed > 12 months after initial DWI, were semi-automatically measured. Clinical characteristics were compared according to evolution patterns on follow-up FLAIR, classified as cavitated, focal lesion without cavitation, and disappeared. Five hundred nine patients were included. Mean time to follow-up was 31.3 ± 13.7 months. Mean diameter of acute lacunar lesions decreased from 12.9 ± 4.4 to 8.5 ± 4.8 mm during follow-up. Lesions of 58.2% patients remained as cavitated, 18.3% as focal lesion without cavitation, and 23.6% disappeared. Initial NIHSS score (p = 0.005), diameter of initial lesion (p < 0.001), number of slices showing acute lesion on DWI (p < 0.001), progression of white matter lesion (p < 0.001), number of acute lesions involving gray matter (p = 0.008) and lesion location (p < 0.001) were different among three groups. After adjustment for covariates, diameter of the acute lesion, initial number of old lacunes, and anterior lesion location were associated with the appearance of cavitation. Initial lesion diameter and posterior lesion location were associated with the disappearance. We observed reduction of the acute lacunar lesion diameter in 86%. There were predictive factors of disappearance and cavitation of acute lacunar infarction.


Lacunar infarction Cavitation Size criteria 



PICASSO study was supported by Korea Otsuka Pharmaceutical Company. SU Kwon received Grants from Korea Otsuka Pharmaceutical Company.

Compliance with ethical standards

Conflicts of interest

The authors have no conflicts of interest to report.

Ethical standards

This study was approved by the ethics committee of each participating center and all participants were enrolled after written informed consent was obtained.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hyuk Sung Kwon
    • 1
  • A-Hyun Cho
    • 2
  • Min Hwan Lee
    • 3
  • Dongwhane Lee
    • 4
  • Da-Eun Jeong
    • 5
  • Changwoon Choi
    • 6
  • Ji-wan Jang
    • 7
  • Sungwook Yu
    • 8
  • Jong-Ho Park
    • 9
  • Sung Hyuk Heo
    • 10
  • Ji-Sung Lee
    • 11
  • Sun U. Kwon
    • 4
    Email author
  • PICASSO investigators
  1. 1.Department of NeurologyHanyang University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Neurology, Yeouido St. Mary’s HospitalCatholic University of Korea, College of MedicineSeoulRepublic of Korea
  3. 3.Department of NeurologyMyongji St. Mary’s HospitalSeoulRepublic of Korea
  4. 4.Department of Neurology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  5. 5.Department of Neurology, Stroke CenterYeungnam University HospitalDaeguRepublic of Korea
  6. 6.Department of NeurologyKorea University Guro HospitalSeoulRepublic of Korea
  7. 7.Department of NeurologyAnyang Medical CenterAnyangRepublic of Korea
  8. 8.Department of NeurologyKorea University College of MedicineSeoulRepublic of Korea
  9. 9.Department of Neurology, Myongji HospitalHanyang University College of MedicineGoyangRepublic of Korea
  10. 10.Department of NeurologyKyung Hee University College of MedicineSeoulRepublic of Korea
  11. 11.Clinical Research Center, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea

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