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J Cereb Blood Flow Metab. 2019 Sep 26:271678X19877403. doi: 10.1177/0271678X19877403. [Epub ahead of print]

Cortical microinfarcts in memory clinic patients are associated with reduced cerebral perfusion.

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Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands.
Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands.
Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands.
Department of Radiology and Nuclear Medicine & Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands.
Memory Aging and Cognition Centre, Department of Pharmacology, National University of Singapore, Singapore, Singapore.
Image Sciences Institute, University Medical Center Utrecht, Utrecht, Netherlands.
Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.
Department of Neurology, J.P.K. Stroke Research Center, Massachusetts General Hospital, Boston, USA.
Raffles Neuroscience Center, Raffles Hospital, Singapore, Singapore.
St. Luke's Hospital, Singapore, Singapore.


Cerebral cortical microinfarcts (CMIs) are small ischemic lesions associated with cognitive impairment and dementia. CMIs are frequently observed in cortical watershed areas suggesting that hypoperfusion contributes to their development. We investigated if presence of CMIs was related to a decrease in cerebral perfusion, globally or specifically in cortex surrounding CMIs. In 181 memory clinic patients (mean age 72 ± 9 years, 51% male), CMI presence was rated on 3-T magnetic resonance imaging (MRI). Cerebral perfusion was assessed from cortical gray matter of the anterior circulation using pseudo-continuous arterial spin labeling parameters cerebral blood flow (CBF) (perfusion in mL blood/100 g tissue/min) and spatial coefficient of variation (CoV) (reflecting arterial transit time (ATT)). Patients with CMIs had a 12% lower CBF (beta = -.20) and 22% higher spatial CoV (beta = .20) (both p < .05) without a specific regional pattern on voxel-based CBF analysis. CBF in a 2 cm region-of-interest around the CMIs did not differ from CBF in a reference zone in the contralateral hemisphere. These findings show that CMIs in memory clinic patients are primarily related to global reductions in cerebral perfusion, thus shedding new light on the etiology of vascular brain injury in dementia.


Arterial spin labeling; cerebral perfusion; dementia; microinfarct; vascular cognitive impairment


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