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Thalamic Lesions in Vascular Dementia: Low Sensitivity of Fluid-Attenuated Inversion Recovery (FLAIR) Imaging
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Advisor(s)
Abstract(s)
Background and Purpose—The criteria of the National Institute of Neurological Disorders and Stroke (NINDS)–
Association Internationale pour la Recherche et l’Enseignement en Neurosciences (AIREN) include thalamic lesions for
the diagnosis of vascular dementia (VaD). Although studies concerning VaD and brain aging advocate the use of
fluid-attenuated inversion recovery (FLAIR) or T2-weighted images (T2-WI) to detect ischemic lesions, none compared
the sensitivity of these sequences to depict thalamic lesions.
Methods—We performed a blinded review of T2-WI and FLAIR images in 73 patients fulfilling the radiological part of the NINDS-AIREN criteria (mean age, 71 years; range, 49 to 83 years). This sample was drawn from a large multicenter trial on VaD and was expected to have a high prevalence of thalamic lesions. In a side-by-side review, including T1-weighted images as well, lesions were classified according to presumed underlying pathology.
Results—The total number of thalamic lesions was 214. Two hundred eight (97%) were detected on T2-WI, but only 117
(55%) were detected on FLAIR ( 2 5.1; P 0.05). Although the mean size of lesions detected on T2-WI and not on FLAIR (4.4 mm) was significantly lower than the mean size of lesions detected on both sequences (6.7 mm) (P 0.001), 5 of the 29 lesions 10 mm on T2-WI were not visible on FLAIR. FLAIR detected only 81 (51%) of the 158 probable ischemic lesions and 30 (60%) of the 50 probable microbleeds.
Conclusions—FLAIR should not be used as the only T2-weighted sequence to detect thalamic lesions in patients suspected
of having VaD.
Description
Keywords
dementia, vascular magnetic resonance imaging thalamus
Citation
Stroke. 2004;35:415-419.
Publisher
American Heart Association