AI Article Synopsis
- White matter hyperintensities (WMHs) seen on T2/FLAIR brain MRI are common in healthy elderly individuals, but their relationship to permanent brain damage is still debated.
- A study found substantial agreement between neuropathologists regarding demyelination, but only fair to moderate agreement among radiologists, indicating a discrepancy in interpreting the lesions' severity.
- Overall, T2/FLAIR MRI tends to overestimate demyelination in periventricular regions while underestimating it in deep white matter, likely due to changes in brain aging that affect water content and blood-brain barrier function.
Article Abstract
Background: White matter hyperintensities (WMH) lesions on T2/FLAIR brain MRI are frequently seen in healthy elderly people. Whether these radiological lesions correspond to irreversible histological changes is still a matter of debate. We report the radiologic-histopathologic concordance between T2/FLAIR WMHs and neuropathologically confirmed demyelination in the periventricular, perivascular and deep white matter (WM) areas.
Results: Inter-rater reliability was substantial-almost perfect between neuropathologists (kappa 0.71 - 0.79) and fair-moderate between radiologists (kappa 0.34 - 0.42). Discriminating low versus high lesion scores, radiologic compared to neuropathologic evaluation had sensitivity / specificity of 0.83 / 0.47 for periventricular and 0.44 / 0.88 for deep white matter lesions. T2/FLAIR WMHs overestimate neuropathologically confirmed demyelination in the periventricular (p < 0.001) areas but underestimates it in the deep WM (0 < 0.05). In a subset of 14 cases with prominent perivascular WMH, no corresponding demyelination was found in 12 cases.
Conclusions: MRI T2/FLAIR overestimates periventricular and perivascular lesions compared to histopathologically confirmed demyelination. The relatively high concentration of interstitial water in the periventricular / perivascular regions due to increasing blood-brain-barrier permeability and plasma leakage in brain aging may evoke T2/FLAIR WMH despite relatively mild demyelination.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893472 | PMC |
| http://dx.doi.org/10.1186/2051-5960-1-14 | DOI Listing |
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