Subcortical lacunar lesions: an MR imaging finding in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
OBJECTIVE
To assess the prevalence and distribution of subcortical lacunar lesions (SLLs) in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), to determine whether SLLs are an abnormal finding by studying their prevalence in healthy subjects, and to assess whether SLLs occur in other conditions associated with small vessel disease and white matter areas of high signal intensity (WMH).


METHODS
The presence of SLLs, their location, and their relation to other abnormalities were assessed on magnetic resonance (MR) images (T1-weighted, T2-weighted, and fluid-attenuated inversion-recovery) obtained in 34 CADASIL patients and 20 healthy family members. Three additional control groups of healthy volunteers, elderly patients with vascular risk factors, and patients with another hereditary small vessel disease were also screened for the presence and location of SLLs. Sensitivity and specificity of the presence of SLLs for the diagnosis of CADASIL were assessed.


RESULTS
SLLs were found in 20 (59%) of CADASIL patients. Incidence of SLLs increased with age (20%, <30 years; 50%, 30-50 years; 80%, >50 years). SLLs invariably occurred in the anterior temporal lobes and in areas where diffuse WMH expanded into arcuate fibers. From the anterior temporal lobe, the lesions could extend dorsally into the temporal lobes and rostrally into the frontal lobes. Lesions were not found in the parietal and occipital lobes. None of the control subjects had SLLs. Specificity and sensitivity of SLLs for CADASIL were 100% and 59%, respectively.


CONCLUSIONS
SLLs are an abnormal finding at MR imaging that frequently occur in CADASIL patients.
Department of Radiology, Leiden University Medical Center, Albinusdreef 2, C2S, the Netherlands. r.van_den_boom@lumc.nl
Rivka
R
van Den Boom
Saskia A J
SA
Lesnik Oberstein
Sjoerd G
SG
van Duinen
Marjolijn
M
Bornebroek
Michel D
MD
Ferrari
Joost
J
Haan
Mark A
MA
van Buchem
D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D002539:Cerebral Arterial Diseases / Q000151:congenital / Q000000981:diagnostic imaging* / Q000235:genetics*; D002544:Cerebral Infarction / Q000150:complications* / Q000000981:diagnostic imaging; D015140:Dementia, Vascular / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D005799:Genes, Dominant; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012680:Sensitivity and Specificity