PT  - JOURNAL ARTICLE
AU  - Wiegertjes, Kim
AU  - ter Telgte, Annemieke
AU  - Oliveira, Pedro B.
AU  - van Leijsen, Esther M.C.
AU  - Bergkamp, Mayra I.
AU  - van Uden, Ingeborg W.M.
AU  - Ghafoorian, Mohsen
AU  - van der Holst, Helena M.
AU  - Norris, David G.
AU  - Platel, Bram
AU  - Klijn, Catharina J.M.
AU  - Tuladhar, Anil M.
AU  - de Leeuw, Frank-Erik
TI  - The role of small diffusion-weighted imaging lesions in cerebral small vessel disease
AID  - 10.1212/WNL.0000000000008364
DP  - 2019 Oct 22
TA  - Neurology
PG  - e1627--e1634
VI  - 93
IP  - 17
4099  - http://n.neurology.org/content/93/17/e1627.short
4100  - http://n.neurology.org/content/93/17/e1627.full
SO  - Neurology2019 Oct 22; 93
AB  - Objective To investigate the prevalence of asymptomatic diffusion-weighted imaging–positive (DWI+) lesions in individuals with cerebral small vessel disease (SVD) and identify their role in the origin of SVD markers on MRI.Methods We included 503 individuals with SVD from the Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort (RUN DMC) study (mean age 65.6 years [SD 8.8], 56.5% male) with 1.5T MRI in 2006 and, if available, follow-up MRI in 2011 and 2015. We screened DWI scans (n = 1,152) for DWI+ lesions, assessed lesion evolution on follow-up fluid-attenuated inversion recovery, T1 and T2* images, and examined the association between DWI+ lesions and annual SVD progression (white matter hyperintensities [WMH], lacunes, microbleeds).Results We found 50 DWI+ lesions in 39 individuals on 1,152 DWI (3.4%). Individuals with DWI+ lesions were older (p = 0.025), more frequently had a history of hypertension (p = 0.021), and had a larger burden of preexisting SVD MRI markers (WMH, lacunes, microbleeds: all p < 0.001) compared to individuals without DWI+ lesions. Of the 23 DWI+ lesions with available follow-up MRI, 14 (61%) evolved into a WMH, 8 (35%) resulted in a cavity, and 1 (4%) was no longer visible. Presence of DWI+ lesions was significantly associated with annual WMH volume increase and yearly incidence of lacunes and microbleeds (all p < 0.001).Conclusion Over 3% of individuals with SVD have DWI+ lesions. Although DWI+ lesions play a role in the progression of SVD, they may not fully explain progression of SVD markers on MRI, suggesting that other factors than acute ischemia are at play.CAA=cerebral amyloid angiopathy; CI=confidence interval; DTI=diffusion tensor imaging; DWI+=diffusion-weighted imaging–positive; FLAIR=fluid-attenuated inversion recovery; ICV=intracranial volume; MD=mean diffusivity; MMSE=Mini-Mental State Examination; RUN DMC=Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Imaging Cohort; STRIVE=Standards for Reporting Vascular Changes on Neuroimaging; SVD=small vessel disease; VIF=variance inflation factor; WMH=white matter hyperintensities