Classification of White Matter Lesions on Magnetic Resonance Imaging in Elderly Persons

Abstract

White matter lesions, commonly seen on magnetic resonance images of elderly people, are related to various geriatric disorders including cerebrovascular diseases, cardiovascular diseases, dementia, and psychiatric disorders. Currently, white matter lesions are divided into periventricular white matter lesions and deep white matter lesions. Although the meaning of these terms vary by study and this dichotomization itself is still in debate, a possible dissimilarity in pathogenic mechanisms between periventricular white matter lesions and deep white matter lesions are providing some clues for understanding pathophysiology of many geriatric syndromes associated with white matter lesions.We have reviewed the distinctions between periventricular white matter lesions and deep white matter lesions in terms of etiology, histopathology, functional correlates, and imaging methodologies. We suggest a new sub-classification of white matter lesions which may have better etiological and functional relevance than the current simple dichotomization. The new categories are juxtaventricular, periventricular, deep white, and juxtacortical. This new classification scheme may contribute to reducing the heterogeneity of white matter lesion findings in future research.

Tract-Specific Fractional Anisotropy Predicts Cognitive Outcome in a Community Sample of Middle-Aged Participants with White Matter Lesions

“…3 Vascularrelated changes are usually associated with high-grade DWMHs, whereas non-ischemic age-related changes are usually related to PVHs. 3,16 Specifically, the diagnosis of arterial hypertension was related to high-grade DWMHs in our sample. Only severe PVHs extending to deep WM are clearly vascular-related changes, but none of our participants with high-grade PVHs were rated with severe lesions.…”

The Spectrum of MR Detectable Cortical Microinfarcts: A Classification Study with 7-Tesla Postmortem MRI and Histopathology

“…Also, the u-fibers are frequently spared in the case of widespread whitematter lesions. 23 Enlarged PVSs are a common finding in the white matter, especially in the context of CAA. 24 In our study, MR identified 'lesions' in juxtacortical areas that had similar appearance as intracortical CMIs proved to be PVSs on histology.…”

The Topography of White Mater Peri-Ventricular Hyperintensities on Brain Magnetic Resonance Imagings (MRI) Among Cameroonians

“…Peri-Ventricular Hyperintensity (PVH) as the name connotes refers to homogenous high signals contiguous to lateral ventricles on T2 weighted (T2W), Fluid Attenuated Inversion Recovery (FLAIR), and Proton Density (PD) images, without prominent hypointensity on T1 weighted (T1W) MR images [1][2][3][4][5]. They are differentiated from infarcts as they are not usually evident on T1W MR images and they do not follow specific vascular territories [2].…”

“…(2) Geriatric disorders like cerebrovascular diseases (CVD), cardiovascular diseases and Dementia, [4]. [3][4][5]9,11,[17][18][19][20][21][22][23][24][25][26].…”

“…[3][4][5]9,11,[17][18][19][20][21][22][23][24][25][26]. Neuropathologically, PVH has been reported to represent demyelination, gliosis, and spongiosis [19].…”