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Relationship Between White Matter Hyperintensities Penumbra and Cavity Formation

Xiaoyu Zhang, Lingling Ding, Lei Yang, Wei Qin, Yue Li, Shujuan Li, Wenli Hu

(Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland))

Med Sci Monit 2016; 22:41-49

DOI: 10.12659/MSM.896324

Published: 2016-01-05

BACKGROUND: Penumbra has been detected on the edge of white matter hyperintensities (WMH). The aim of our study was to investigate whether cavity formation is different between acute infarcts on the edge of WMH and those away from the edge.
MATERIAL AND METHODS: Ninety-six subjects with acute lacunar infarct ≤25 mm in diameter were recruited. Subjects with infarct contacting or overlapping with WMH (on axial T2 or coronal FLAIR) were defined as the Edge Group (on the edge of the WMH). Those outside the edge of the WMH were the Non-edge Group. Vascular risk factors, clinical data, baseline infarct size, infarct sites, and severity of WMH (by Fazekas scale) were recorded. Cavity formation was identified by MR follow-up imaging. Risk factors for cavity formation were also investigated.
RESULTS: There were 37 (38.5%) subjects in the Edge Group and 59 (61.5%) in the Non-edge Group; 55 (57.3%) subjects had cavity formation in follow-up imaging. Subjects in the Edge Group had higher risk of developing cavities than those in the Non-edge Group (78.4% vs. 44.1%, p<0.05). In univariate analysis, subjects with cavity formation had larger infarct size and their infarcts were more often located in subcortical white matter. Vascular risk factors, clinical data, and WMH did not differ between subjects with cavity formation and those without. In logistic regression analysis, DWI infarct size and being in the Edge Group were independent risk factors for cavity formation.
CONCLUSIONS: Lacunar infarcts on the edge of WMH are more likely to develop cavities, suggesting that WMH penumbra affects cavity formation.

Keywords: Aged, Adult, Acute Disease, Cerebral Small Vessel Diseases - physiopathology, Female, Follow-Up Studies, Humans, Leukoencephalopathies - physiopathology, Magnetic Resonance Imaging, Male, Middle Aged, Retrospective Studies, Risk Factors, Severity of Illness Index, Stroke - physiopathology, Stroke, Lacunar - physiopathology, White Matter - physiopathology