Skip to main content
SpringerLink
Log in

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

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

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.

Results

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).

Conclusion

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bernick C, Kuller L, Dulberg C, Longstreth WT, Manolio T, Beauchamp N, Price T (2001) Silent MRI infarcts and the risk of future stroke: the Cardiovascular Health Study. Neurology 57:1222–1229

    PubMed  CAS  Google Scholar 

  2. Vermeer SE, Hollander M, van Dijk EJ, Hofman A, Koudstaal PJ, Breteler MM (2003) Silent brain infarcts and white matter lesions increase stroke risk in the general population: the Rotterdam Scan Study. Stroke 34:1126–1129

    Article  PubMed  Google Scholar 

  3. van der Flier WM, van Straaten CW, Barkhof F, Verdelho A, Madureira S, Pantoni L, Inzitari D, Erkinjuntti T, Crisby M, Waldemar G, Schmidt R, Fazekas F, Scheltens P (2005) Small vessel disease and general cognitive function in nondisabled elderly: the LADIS study. Stroke 36:2116–2120

    Article  PubMed  Google Scholar 

  4. Pantoni L, Poggesi A, Basile AM, Pracucci G, Barkhof F, Chabriat H, Erkinjuntti T, Ferro JM, Hennerici M, O'Brien J, Schmidt R, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D (2006) Leukoaraiosis predicts hidden global functioning impairment in nondisabled older people: the LADIS (leukoaraiosis and disability in the elderly) Study. J Am Geriatr Soc 54:1095–1101

    Article  PubMed  Google Scholar 

  5. Braffman BH, Zimmerman RA, Trojanowski JQ, Gonatas NK, Hickey WF, Schlaepfer WW (1988) Brain MR: pathologic correlation with gross and histopathology. 1. Lacunar infarction and Virchow–Robin spaces. AJR 151:551–558

    PubMed  CAS  Google Scholar 

  6. Fazekas F, Chawluk JK, Alavi A, Hurtig HI, Zimmerman RA (1987) MR signal abnormalities at 1.5T in Alzheimer’s dementia and normal aging. AJR 149:351–356

    PubMed  CAS  Google Scholar 

  7. Metz CE, Herman BA, Shen JH (1998) Maximum-likelihood estimation of receiver operating characteristic (ROC) curves from continuously-distributed data. Stat Med 17:1033–1053

    Article  PubMed  CAS  Google Scholar 

  8. Longstreth WT, Bernick C, Manolio TA, Bryan N, jungreis CA, Price TR (1998) Lacunar infarcts defined by magnetic resonance imaging of 3660 elderly people: the Cardiovascular Health Study. Arch Neurol 55:1217–1225

    Article  PubMed  Google Scholar 

  9. Longstreth WT, Dulberg C, Manolio TA, Lewis MR, Beauchamp NJ, O’Leary D, Carr J, Furberg CD (2002) Incidence, manifestations, and predictors of brain infarcts defined by serial cranial magnetic resonance imaging in the elderly: the Cardiovascular Health Study. Stroke 33:2376–2382

    Article  PubMed  Google Scholar 

  10. Vermeer SE, den Heijer T, Koudstaal PJ, Oudkerk M, Hofman A, Breteler MMB (2003) Incidence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. Stroke 34:392–396

    Article  PubMed  Google Scholar 

  11. de Leeuw FE, de Groot JC, Achten E, Oudkerk M, Ramos LM, Heijboer R, Hofman A, Jolles J, van Gijn J, Breteler MM (2001) Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study. The Rotterdam Scan Study. J Neurol Neurosurg Psychiatr 70:9–14

    Article  PubMed  Google Scholar 

  12. Longstreth WT, Arnold AM, Beauchamp NJ Jr, Manolio TA, Lefkowitz D, Jungreis C, Hirsch CH, O’Leary DH, Furberg CD (2005) Incidence, manifestations, and predictors of worsening white matter on serial cranial magnetic resonance imaging in the elderly: the Cardiovascular Health Study. Stroke 36:56–61

    Article  PubMed  Google Scholar 

  13. Awad IA, Johnson PC, Spetzler RF, Hodak JA (1986) Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. II. Postmortem pathological correlations. Stroke 17:1090–1097

    PubMed  CAS  Google Scholar 

  14. Chimowitz MI, Estes ML, Furlan AJ, Awad IA (1992) Further observations on the pathology of subcortical lesions identified on magnetic resonance imaging. Arch Neurol 49:747–752

    PubMed  CAS  Google Scholar 

  15. Matsusue E, Sugihara S, Fujii S, Ohama E, Konishita T, Ogawa T (2006) White matter changes in elderly people: MR-pathologic correlations. Magn Reson Med Sci 5:99–104

    Article  PubMed  Google Scholar 

  16. Shinohara Y, Tohgi H, Hirai S, Terashi A, Fukuuchi Y, Yamaguchi T, Okudera T (2007) Effect of the Ca antagonist nilvadipine on stroke occurrence or recurrence and extension of asymptomatic cerebral infarction in hypertensive patients with or without history of stroke (PICA study). Cerebrovasc Dis 24:202–209

    Article  PubMed  CAS  Google Scholar 

  17. Bokura H, Kobayashi S, Yamaguchi S (1998) Distinguishing silent lacunar infarction from enlarged Virchow-Robin spaces: a magnetic resonance imaging and pathological study. J Neurol 245:116–122

    Article  PubMed  CAS  Google Scholar 

  18. Okuda T, Korogi Y, Shigematsu Y, Sugahara T, Hirai T, Ikushima I, Lian L, Takahashi M (1999) Brain lesions: when should fluid-attenuated inversion recovery sequences be used in MR evaluation? Radiology 212:793–798

    PubMed  CAS  Google Scholar 

Download references

Acknowledgment

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.

Author information

Authors and Affiliations

  1. Advanced Medical Research Center, Iwate Medical University, 19-1 Uchimaru, Morioka, 020-8505, Japan

    Makoto Sasaki

  2. Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan

    Toshinori Hirai

  3. Department of Radiology, Nara Prefectural Medical University, 840 Shijo-cho, Kashihara, 634-8521, Japan

    Toshiaki Taoka

  4. Department of Diagnostic Radiology, Tohoku University School of Medicine, 1-1 Seiryo-cho, Sendai, 980-8574, Japan

    Shuichi Higano

  5. Department of Radiology, Suiseikai Kajikawa Hospital, 8-20 Showa-machi, Hiroshima, 730-046, Japan

    Chieko Wakabayashi

  6. Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan

    Eiji Matsusue

  7. Department of Radiology, Ebara Hospital, 4-5-10 Higashi-Yukigaya, Tokyo, 145-0065, Japan

    Masahiro Ida

Authors
  1. Makoto Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshinori Hirai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toshiaki Taoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shuichi Higano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chieko Wakabayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eiji Matsusue
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masahiro Ida
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Makoto Sasaki.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sasaki, M., Hirai, T., Taoka, T. et al. Discriminating between silent cerebral infarction and deep white matter hyperintensity using combinations of three types of magnetic resonance images: a multicenter observer performance study. Neuroradiology 50, 753–758 (2008). https://doi.org/10.1007/s00234-008-0406-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-008-0406-6

Keywords

Search

Navigation