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Subcortical Lacunar Lesions: An MR Imaging Finding in Patients with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy¹

¹ From the Departments of Radiology (R.v.d.B., M.A.v.B.), Clinical Genetics (S.A.J.L.O.), Pathology (S.G.v.D.), and Neurology (M.B., M.D.F.), Leiden University Medical Center, Albinusdreef 2, C2S, 2333 ZA Leiden, the Netherlands; and Department of Neurology, Rijnland Hospital, Leiderdorp, the Netherlands (J.H.). From the 2001 RSNA scientific assembly. Received June 28, 2001; revision requested August 16; revision received October 29; accepted December 11. Address correspondence to R.v.d.B. (e-mail: r.van_den_boom@lumc.nl).

View larger version (136K): [in a new window]   Figure 1a. Transverse MR images in patient with CADASIL at the level of the pons. Hyperintense confluent white matter lesions in the temporal lobe are visible on (a) a FLAIR image (8,000/100/2,000) and (b) a T2-weighted image (3,000/120). On the FLAIR image, the SLLs (arrowheads) are clearly visible, whereas on the T2-weighted image they can hardly be discriminated from the adjacent WMH.

View larger version (142K): [in a new window]   Figure 1b. Transverse MR images in patient with CADASIL at the level of the pons. Hyperintense confluent white matter lesions in the temporal lobe are visible on (a) a FLAIR image (8,000/100/2,000) and (b) a T2-weighted image (3,000/120). On the FLAIR image, the SLLs (arrowheads) are clearly visible, whereas on the T2-weighted image they can hardly be discriminated from the adjacent WMH.

View larger version (134K): [in a new window]   Figure 2a. Transverse FLAIR MR images (8,000/100/2,000) in four CADASIL patients at the level of (a) the pons, (b) the operculum of the temporal lobe, (c) the basal ganglia, and (d) the high convexity. Images show bilateral SLLs affecting (a) the anterior part and (b) the operculum of the temporal lobe (arrowheads) at the junction of gray and white matter. The lesions are abutting WMH (arrow in a). From this location, lesions could expand to (c) the subinsular region and operculum of the frontal lobe (arrowheads). (d) In one patient with extensive white matter lesions, subcortical lacunar lesions were visible throughout the whole frontal lobe (arrows).

View larger version (132K): [in a new window]   Figure 2b. Transverse FLAIR MR images (8,000/100/2,000) in four CADASIL patients at the level of (a) the pons, (b) the operculum of the temporal lobe, (c) the basal ganglia, and (d) the high convexity. Images show bilateral SLLs affecting (a) the anterior part and (b) the operculum of the temporal lobe (arrowheads) at the junction of gray and white matter. The lesions are abutting WMH (arrow in a). From this location, lesions could expand to (c) the subinsular region and operculum of the frontal lobe (arrowheads). (d) In one patient with extensive white matter lesions, subcortical lacunar lesions were visible throughout the whole frontal lobe (arrows).

View larger version (132K): [in a new window]   Figure 2c. Transverse FLAIR MR images (8,000/100/2,000) in four CADASIL patients at the level of (a) the pons, (b) the operculum of the temporal lobe, (c) the basal ganglia, and (d) the high convexity. Images show bilateral SLLs affecting (a) the anterior part and (b) the operculum of the temporal lobe (arrowheads) at the junction of gray and white matter. The lesions are abutting WMH (arrow in a). From this location, lesions could expand to (c) the subinsular region and operculum of the frontal lobe (arrowheads). (d) In one patient with extensive white matter lesions, subcortical lacunar lesions were visible throughout the whole frontal lobe (arrows).

View larger version (137K): [in a new window]   Figure 2d. Transverse FLAIR MR images (8,000/100/2,000) in four CADASIL patients at the level of (a) the pons, (b) the operculum of the temporal lobe, (c) the basal ganglia, and (d) the high convexity. Images show bilateral SLLs affecting (a) the anterior part and (b) the operculum of the temporal lobe (arrowheads) at the junction of gray and white matter. The lesions are abutting WMH (arrow in a). From this location, lesions could expand to (c) the subinsular region and operculum of the frontal lobe (arrowheads). (d) In one patient with extensive white matter lesions, subcortical lacunar lesions were visible throughout the whole frontal lobe (arrows).

View larger version (153K): [in a new window]   Figure 3a. (a) Transverse FLAIR MR image (8,000/100/2,000) in a patient with CADASIL in whom we obtained formalin-fixed tissue of the anterior temporal lobe after death. Subcortical lacunar lesions are present in the temporal lobe (arrowhead). (b) Photomicrograph shows a row of perforating vessels at the border of gray matter (top of image) and white matter with an obvious clear zone (arrowheads). (Klüver-Barrera stain; original magnification, x20.) (c) Photomicrograph shows detail of two vessels. The lower part of the vessel on the left shows characteristic thickening of the arterial wall; both vessels have a distended perivascular space (arrows) and spongiosis of the adjacent parenchyma (arrowhead). (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (128K): [in a new window]   Figure 3b. (a) Transverse FLAIR MR image (8,000/100/2,000) in a patient with CADASIL in whom we obtained formalin-fixed tissue of the anterior temporal lobe after death. Subcortical lacunar lesions are present in the temporal lobe (arrowhead). (b) Photomicrograph shows a row of perforating vessels at the border of gray matter (top of image) and white matter with an obvious clear zone (arrowheads). (Klüver-Barrera stain; original magnification, x20.) (c) Photomicrograph shows detail of two vessels. The lower part of the vessel on the left shows characteristic thickening of the arterial wall; both vessels have a distended perivascular space (arrows) and spongiosis of the adjacent parenchyma (arrowhead). (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (144K): [in a new window]   Figure 3c. (a) Transverse FLAIR MR image (8,000/100/2,000) in a patient with CADASIL in whom we obtained formalin-fixed tissue of the anterior temporal lobe after death. Subcortical lacunar lesions are present in the temporal lobe (arrowhead). (b) Photomicrograph shows a row of perforating vessels at the border of gray matter (top of image) and white matter with an obvious clear zone (arrowheads). (Klüver-Barrera stain; original magnification, x20.) (c) Photomicrograph shows detail of two vessels. The lower part of the vessel on the left shows characteristic thickening of the arterial wall; both vessels have a distended perivascular space (arrows) and spongiosis of the adjacent parenchyma (arrowhead). (Hematoxylin-eosin stain; original magnification, x100.)