Subcortical lesion-classification-CNUH-definition-2011-10-10

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The Definitions of Subcortical lesions, Lacunes, Microbleeds, and Subcortical White Matter Change at CNUH

Subcortical lesions 1. Perivascular spaces (etatcrible) 2. Lacunes 3. Subcortical white matter changes 4. Microbleeds

1. Perivascular spaces (etatcrible) ,[object Object],: the punctiform dilatations of the perivascular spaces often seen by brain MRI in the white matter and in the basal ganglia

2. Lacunes ,[object Object],(ref. 2) : small hyperintense lesions on T2WI (ref. 2) : corresponding distinctive low intensity area on T1WI : Maximum size of lacune (ref. 4) - with a diameter of 5-10 mm : On CT (ref. 4) - areas of more or less complete focal tissue destruction - clearly defined borders with marked central hypodensity on CT : On MRI (ref. 4) - low intensity on T1WI, proton-density and FLAIR scans - high intensity on T2WI -> isointense to CSF

2. Lacunes ,[object Object],(ref. 2) Absent (2) Mild – 1-3 (3) Moderate – 4-10 (4) Severe - >10 ,[object Object],(ref. 2) Cortico-subcortical (2) Basal ganglia (3) Thalamus (4) Brain stem (5) Cerebellum

3. Subcortical white matter change ,[object Object], (ref. 6) (1) White matter lesions 0 = no lesions (including symmetrical, well-defined caps or bands) 1 = Focal lesions 2 = Beginning confluence of lesions 3 = Diffuse involvement of the entire region, with or without involvement of U fibers (2) Basal ganglia lesions 0 = No lesions 1 = 1 focal lesion (≥ 5 mm) 2 = > 1 focal lesion 3 = Confluent lesions

3. Subcortical white matter change (1) White matter lesions 1 = Focal lesions

3. Subcortical white matter change (1) White matter lesions 2 = Beginning confluence of lesions

3. Subcortical white matter change (1) White matter lesions 3 = Diffuse involvement of the entire region, with or without involvement of U fibers (M/75)

3. Subcortical white matter change (1) White matter lesions 3 = Diffuse involvement of the entire region, with or without involvement of U fibers (M/60)

3. Subcortical white matter change (2) Basal ganglia lesions 1 = 1 focal lesion (≥ 5 mm)

3. Subcortical white matter change (2) Basal ganglia lesions 2 = > 1 focal lesion

3. Subcortical white matter change (2) Basal ganglia lesions 3 = Confluent lesions

4. Microbleeds ,[object Object],(1) Homogeneous round signal loss lesion with a diameter of up to 5 mm (or <10 mm) on gradient echo image Distinct from a. Vascular flow voids on subarachnoid space b. Leptomeningealhemasiderosis c. Non-hemorrhagic subcortical mineralization

4. Microbleeds ,[object Object],[object Object]

Intracranial vessel stenosis (ref. 7) 2. Location of stenosis MCA – 1 and 2 ACA – 3 and 4 PCA – 5 and 6 Siphon ICA – 7 and 8 Extracranial ICA - 9 and 10 Vertebrobasilar artery – 11

Intracranial vessel stenosis (ref. 7) 3. Measurement of stenosis

Extracranial vessels stenosis 1) Severity of intracranial stenosis (ref. 11, 12) (1) Mild - <30% (2) Moderate – 30% - 69% (3) Severe – 70% - 99% - in case of segmental signal void -> the stenosis was graded as severe (>70%) (4) Occluded

Extracranial vessels stenosis 2) Measurement of the carotid artery stenosis (ref. 12) (1) NASCET : (1-md/C)x100% (2) ECST : (1-md/B)x100% (3) CC : (1-md/A)x100%

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Subcortical lesion-classification-CNUH-definition-2011-10-10

1. The Definitions of Subcortical lesions, Lacunes, Microbleeds, and Subcortical White Matter Change at CNUH

2. Subcortical lesions 1. Perivascular spaces (etatcrible) 2. Lacunes 3. Subcortical white matter changes 4. Microbleeds

4. M/80, 2011. 10. 13

6. M/80, 2011. 10. 13

9. 3. Subcortical white matter change (1) White matter lesions 1 = Focal lesions

10. 3. Subcortical white matter change (1) White matter lesions 2 = Beginning confluence of lesions

11. 3. Subcortical white matter change (1) White matter lesions 3 = Diffuse involvement of the entire region, with or without involvement of U fibers (M/75)

12. 3. Subcortical white matter change (1) White matter lesions 3 = Diffuse involvement of the entire region, with or without involvement of U fibers (M/60)

13. 3. Subcortical white matter change (2) Basal ganglia lesions 1 = 1 focal lesion (≥ 5 mm)

14. 3. Subcortical white matter change (2) Basal ganglia lesions 2 = > 1 focal lesion

15. 3. Subcortical white matter change (2) Basal ganglia lesions 3 = Confluent lesions

16.

17.

18. Intracranial vessel stenosis (ref. 7) 2. Location of stenosis MCA – 1 and 2 ACA – 3 and 4 PCA – 5 and 6 Siphon ICA – 7 and 8 Extracranial ICA - 9 and 10 Vertebrobasilar artery – 11

19. Intracranial vessel stenosis (ref. 7) 3. Measurement of stenosis

20. Extracranial vessels stenosis 1) Severity of intracranial stenosis (ref. 11, 12) (1) Mild - <30% (2) Moderate – 30% - 69% (3) Severe – 70% - 99% - in case of segmental signal void -> the stenosis was graded as severe (>70%) (4) Occluded

21. Extracranial vessels stenosis 2) Measurement of the carotid artery stenosis (ref. 12) (1) NASCET : (1-md/C)x100% (2) ECST : (1-md/B)x100% (3) CC : (1-md/A)x100%

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