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Lesion probability maps of white matter hyperintensities in elderly individuals

Results of the Austrian stroke prevention study

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Abstract

Objective

White matter hyperintensities (WMH) are common on brain MRI of the elderly. Their size ranges from punctate to early confluent to confluent lesions. While this increase in extension is frequently seen as evidence for a continuum of changes, histological data and clinical follow-up suggest differences in underlying pathology and their progression.

Methods

We tested this hypothesis by exploring the distributions of punctuate and confluent lesions using lesion probability maps (LPM) generated from MRI scans of 189 participants (mean age 60.8+/−6.2 years) in the Austrian Stroke Prevention Study. We dichotomised WMH according to the classification by Fazekas et al. [punctate (n=143) vs. early confluent and confluent (n=33)] to run voxel-based t-tests using permutation-based nonparametric inference. To test alternative hypotheses, we created similar LPM for age and arterial hypertension.

Results

We observed significant differences in the spatial distribution of lesions for the two WMH groups (p<0.01). Punctate lesions were more diffusely distributed throughout the cerebral white matter (peak probability ∼5%) relative to confluent lesions (peak probability 45%). Confluent lesions had greatest likelihood of being found in perfusion “watershed” regions. These differences in distribution could not be explained by differences in age or hypertension only, as both greater age and the diagnosis of hypertension were associated with WMH abutting the occipital horns.

Conclusions

Punctate and early confluent to confluent WMH show distinguishable differences in their spatial distribution within a normal elderly population. The pattern of punctate WMH is probably a consequence of mixed etiologies. Preferential localization of the more confluent WMH with arterial watershed areas implies a stronger ischemic component in their development.

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Acknowledgments and Funding

This work has been supported by the FWF Austrian Science Fund (Vienna; CE and SR, grant number J2373-B02 and P15158, respectively), the UK Medical Research Council (PMM) and an EPSRC Advanced Research Fellowship (SS). We also thank all study participants for their enthusiasm with this project. There are no possible conflicts of interest.

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Authors and Affiliations

  1. Department of Neurology, Medical University Graz, Auenbruggerplatz 22, 8036, Graz, Austria

    Christian Enzinger MD, Franz Fazekas MD, Stefan Ropele PhD & Reinhold Schmidt MD

  2. Division of Neuroradiology, Department of Radiology, Medical University, Graz, Austria

    Christian Enzinger MD & Franz Fazekas MD

  3. MR Research Unit, Medical University, Graz, Austria

    Stefan Ropele PhD

  4. The Centre for Functional MRI of the Brain John Radcliffe Hospital, University of Oxford, UK

    Christian Enzinger MD, Stephen Smith Dphil, Timothy Behrens Dphil & Paul M. Matthews MD, DPhil, FRCP

  5. The School for Computer, Statistical and Mathematical Sciences, Potchefstroom University for CHE, South Africa and School of Computing Science Riddlesex University, United Kingdom

    Gunther Drevin PhD

  6. The Department of Biostatistics, University of Michigan, USA

    Thomas Nichols PhD

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  1. Christian Enzinger MD
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  2. Stephen Smith Dphil
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  3. Franz Fazekas MD
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  4. Gunther Drevin PhD
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  5. Stefan Ropele PhD
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  6. Thomas Nichols PhD
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  7. Timothy Behrens Dphil
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  8. Reinhold Schmidt MD
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  9. Paul M. Matthews MD, DPhil, FRCP
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Corresponding author

Correspondence to Christian Enzinger MD.

Additional information

Received in revised form: 31 October 2005

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Enzinger, C., Smith, S., Fazekas, F. et al. Lesion probability maps of white matter hyperintensities in elderly individuals. J Neurol 253, 1064–1070 (2006). https://doi.org/10.1007/s00415-006-0164-5

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  • DOI: https://doi.org/10.1007/s00415-006-0164-5

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