Document Detail

Distinguishing silent lacunar infarction from enlarged Virchow-Robin spaces: a magnetic resonance imaging and pathological study.
MedLine Citation:
PMID:  9507419     Owner:  NLM     Status:  MEDLINE    
We studied clinicopathological correlations between magnetic resonance imaging (MRI) appearances of postmortem brains and pathological findings in 12 patients to identify simple criteria with which to distinguish lacunar infarctions from enlarged Virchow-Robin spaces. In vivo MRI was also available for 6 of the 12 patients. We focused on small, silent, focal lesions including lacunar infarctions and enlarged Virchow-Robin spaces that were confirmed pathologically. From a total of 114 lesions, enlarged Virchow-Robin spaces were most often found in the basal ganglia and had a round or linear shape. Lacunar infarctions also were most frequent in the basal ganglia, but 47% of these were wedge-shaped. In the pathological studies, excluding lesions from the lower basal ganglia region, enlarged Virchow-Robin spaces were usually smaller than 2 x 1 mm. The shapes and sizes of the lesions determined by MRI (in vivo and postmortem) concurred with the pathological findings, except that on MRI the lesions appeared to be about 1 mm larger than found in the pathological study. When lesions from the lower basal ganglia and the brain stem regions are excluded, the sensitivity and specificity for discriminating enlarged Virchow-Robin spaces from lacunar infarctions are optimal when their size is 2 x 1 mm or less in the pathological study (79%/75%, respectively), 2 x 2 mm or less in both of the MRI studies: postmortem (81%/90%), and in vivo (86%/91%). In conclusion, we were able to differentiate most lacunar infarctions from enlarged Virchow-Robin spaces on MRI on the basis of their location, shape and size. We stress that size is the most important factor used to discriminate these lesions on MRI.
H Bokura; S Kobayashi; S Yamaguchi
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurology     Volume:  245     ISSN:  0340-5354     ISO Abbreviation:  J. Neurol.     Publication Date:  1998 Feb 
Date Detail:
Created Date:  1998-06-04     Completed Date:  1998-06-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0423161     Medline TA:  J Neurol     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  116-22     Citation Subset:  IM    
Department of Internal Medicine III, Shimane Medical University, Enya-cho Izumo, Japan.
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MeSH Terms
Aged, 80 and over
Brain / pathology*
Cerebral Infarction / diagnosis*
Diagnosis, Differential
Magnetic Resonance Imaging*
Middle Aged
Comment In:
J Neurol. 1998 Dec;245(12):813-4   [PMID:  9840356 ]

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