Skip to main content
  • American Heart Association
  • Science Volunteer
  • Warning Signs
  • Advanced Search
  • Donate

  • Home
  • About this Journal
    • Editorial Board
    • General Statistics
    • Author Reprints
    • Commercial Reprints
    • Customer Service and Ordering Information
    • Information for Advertisers
  • All Issues
  • Subjects
    • All Subjects
    • Arrhythmia and Electrophysiology
    • Basic, Translational, and Clinical Research
    • Critical Care and Resuscitation
    • Epidemiology, Lifestyle, and Prevention
    • Genetics
    • Heart Failure and Cardiac Disease
    • Hypertension
    • Imaging and Diagnostic Testing
    • Intervention, Surgery, Transplantation
    • Quality and Outcomes
    • Stroke
    • Vascular Disease
  • Browse Features
    • Editor Picks
    • Blogging Stroke
    • AHA/ASA Guidelines and Statements
    • ISC and Nursing Symposium Abstracts
    • Progress and Innovation Award Recipients
    • Acknowledgment of Reviewers
    • Stroke in Women
    • Outstanding Reviewers 2017
  • Resources
    • Online Submission/Peer Review
    • Instructions for Authors
    • → Article Types
    • → General Preparation Instructions
    • → Research Guidelines
    • → How to Submit a Manuscript
    • → Tips for Submission
    • → Links and Forms
    • → Revised Manuscripts
    • Costs to Authors
    • Journal Policies
    • Wolters Kluwer Author Services
    • Early Career Resources
    • Stroke CME
    • Webinar Series
    • Permissions and Rights Q&A
    • AHA Newsroom
  • AHA Journals
    • AHA Journals Home
    • Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB)
    • Circulation
    • → Circ: Arrhythmia and Electrophysiology
    • → Circ: Genomic and Precision Medicine
    • → Circ: Cardiovascular Imaging
    • → Circ: Cardiovascular Interventions
    • → Circ: Cardiovascular Quality & Outcomes
    • → Circ: Heart Failure
    • Circulation Research
    • Hypertension
    • Stroke
    • Journal of the American Heart Association
  • Facebook
  • Twitter

  • My alerts
  • Sign In
  • Join

  • Advanced search

Header Publisher Menu

  • American Heart Association
  • Science Volunteer
  • Warning Signs
  • Advanced Search
  • Donate

Stroke

  • My alerts
  • Sign In
  • Join

  • Facebook
  • Twitter
  • Home
  • About this Journal
    • Editorial Board
    • General Statistics
    • Author Reprints
    • Commercial Reprints
    • Customer Service and Ordering Information
    • Information for Advertisers
  • All Issues
  • Subjects
    • All Subjects
    • Arrhythmia and Electrophysiology
    • Basic, Translational, and Clinical Research
    • Critical Care and Resuscitation
    • Epidemiology, Lifestyle, and Prevention
    • Genetics
    • Heart Failure and Cardiac Disease
    • Hypertension
    • Imaging and Diagnostic Testing
    • Intervention, Surgery, Transplantation
    • Quality and Outcomes
    • Stroke
    • Vascular Disease
  • Browse Features
    • Editor Picks
    • Blogging Stroke
    • AHA/ASA Guidelines and Statements
    • ISC and Nursing Symposium Abstracts
    • Progress and Innovation Award Recipients
    • Acknowledgment of Reviewers
    • Stroke in Women
    • Outstanding Reviewers 2017
  • Resources
    • Online Submission/Peer Review
    • Instructions for Authors
    • → Article Types
    • → General Preparation Instructions
    • → Research Guidelines
    • → How to Submit a Manuscript
    • → Tips for Submission
    • → Links and Forms
    • → Revised Manuscripts
    • Costs to Authors
    • Journal Policies
    • Wolters Kluwer Author Services
    • Early Career Resources
    • Stroke CME
    • Webinar Series
    • Permissions and Rights Q&A
    • AHA Newsroom
  • AHA Journals
    • AHA Journals Home
    • Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB)
    • Circulation
    • → Circ: Arrhythmia and Electrophysiology
    • → Circ: Genomic and Precision Medicine
    • → Circ: Cardiovascular Imaging
    • → Circ: Cardiovascular Interventions
    • → Circ: Cardiovascular Quality & Outcomes
    • → Circ: Heart Failure
    • Circulation Research
    • Hypertension
    • Stroke
    • Journal of the American Heart Association
Original Contribution

White Matter Hyperintensities and Their Penumbra Lie Along a Continuum of Injury in the Aging Brain

Pauline Maillard, Evan Fletcher, Samuel N. Lockhart, Alexandra E. Roach, Bruce Reed, Dan Mungas, Charles DeCarli, Owen T. Carmichael
Download PDF
https://doi.org/10.1161/STROKEAHA.113.004084
Stroke. 2014;STROKEAHA.113.004084
Originally published April 29, 2014
Pauline Maillard
From the Imaging of Dementia and Aging Laboratory (P.M., E.F., S.N.L., A.E.R., B.R., D.M., C.D., O.T.C.), Department of Neurology (P.M., E.F., B.R., D.M., C.D., O.T.C.), and Center for Neuroscience (S.N.L., A.E.R., C.D.), University of California, Davis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Evan Fletcher
From the Imaging of Dementia and Aging Laboratory (P.M., E.F., S.N.L., A.E.R., B.R., D.M., C.D., O.T.C.), Department of Neurology (P.M., E.F., B.R., D.M., C.D., O.T.C.), and Center for Neuroscience (S.N.L., A.E.R., C.D.), University of California, Davis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Samuel N. Lockhart
From the Imaging of Dementia and Aging Laboratory (P.M., E.F., S.N.L., A.E.R., B.R., D.M., C.D., O.T.C.), Department of Neurology (P.M., E.F., B.R., D.M., C.D., O.T.C.), and Center for Neuroscience (S.N.L., A.E.R., C.D.), University of California, Davis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alexandra E. Roach
From the Imaging of Dementia and Aging Laboratory (P.M., E.F., S.N.L., A.E.R., B.R., D.M., C.D., O.T.C.), Department of Neurology (P.M., E.F., B.R., D.M., C.D., O.T.C.), and Center for Neuroscience (S.N.L., A.E.R., C.D.), University of California, Davis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Bruce Reed
From the Imaging of Dementia and Aging Laboratory (P.M., E.F., S.N.L., A.E.R., B.R., D.M., C.D., O.T.C.), Department of Neurology (P.M., E.F., B.R., D.M., C.D., O.T.C.), and Center for Neuroscience (S.N.L., A.E.R., C.D.), University of California, Davis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Dan Mungas
From the Imaging of Dementia and Aging Laboratory (P.M., E.F., S.N.L., A.E.R., B.R., D.M., C.D., O.T.C.), Department of Neurology (P.M., E.F., B.R., D.M., C.D., O.T.C.), and Center for Neuroscience (S.N.L., A.E.R., C.D.), University of California, Davis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Charles DeCarli
From the Imaging of Dementia and Aging Laboratory (P.M., E.F., S.N.L., A.E.R., B.R., D.M., C.D., O.T.C.), Department of Neurology (P.M., E.F., B.R., D.M., C.D., O.T.C.), and Center for Neuroscience (S.N.L., A.E.R., C.D.), University of California, Davis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Owen T. Carmichael
From the Imaging of Dementia and Aging Laboratory (P.M., E.F., S.N.L., A.E.R., B.R., D.M., C.D., O.T.C.), Department of Neurology (P.M., E.F., B.R., D.M., C.D., O.T.C.), and Center for Neuroscience (S.N.L., A.E.R., C.D.), University of California, Davis.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Supplemental Materials
  • Info & Metrics
Loading

Abstract

Background and Purpose—Aging is accompanied by clinically silent cerebral white matter injury identified through white matter hyperintensities (WMHs) on fluid-attenuated inversion recovery (FLAIR)– and diffusion tensor imaging–based measures of white matter integrity. The temporal course of FLAIR and diffusion tensor imaging changes within WMHs and their less-injured periphery (ie, their penumbra), however, has not been fully studied. We used longitudinal diffusion tensor imaging and FLAIR to explore these changes.

Methods—One hundred fifteen participants, aged 73.7±6.7 years, received clinical evaluations and MRIs on 2 dates. WMHs and fractional anisotropy (FA) maps were produced from FLAIR and diffusion tensor imaging and coregistered to a standardized space. Each distinct WMH was categorized as growing, stagnant, or noncontiguous incident. The penumbra of each WMH was similarly categorized as corresponding to a stagnant, growing, or noncontiguous incident WMH. Linear mixed-effect models were used to assess whether FA and FLAIR measurements changed between baseline and follow-up and differed between tissue categories.

Results—Baseline FA differed significantly by tissue category, with the following ordering of categories from highest to lowest FA: penumbra of noncontiguous incident, then stagnant, then growing WMHs; noncontiguous incident, then stagnant, then growing WMHs. Despite differences in baseline values, all tissue categories experienced declines in FA over time. Only noncontiguous incident WMHs showed significant FLAIR signal increases over time, and FLAIR signal significantly decreased in stagnant WMHs.

Conclusions—WMHs and their penumbra vary in severity and together span a continuous spectrum of white matter injury that worsens with time. FLAIR fails to capture this continuous injury process fully but does identify a subclass of lesions that seem to improve over time.

  • aging
  • diffusion tensor imaging
  • magnetic resonance imaging
  • neuroimaging
  • Received November 7, 2013.
  • Revision received February 4, 2014.
  • Accepted February 12, 2014.
  • © 2014 American Heart Association, Inc.

Jump to

  • Article
  • Supplemental Materials
  • Info & Metrics
  • eLetters
Back to top
Next Article

Current Issue

Stroke
April 2018, Volume 49, Issue 4
  • Table of Contents
Next Article

Jump to

  • Article
  • Supplemental Materials
  • Info & Metrics

Article Tools

  • Print
  • Citation Tools
    White Matter Hyperintensities and Their Penumbra Lie Along a Continuum of Injury in the Aging Brain
    Pauline Maillard, Evan Fletcher, Samuel N. Lockhart, Alexandra E. Roach, Bruce Reed, Dan Mungas, Charles DeCarli and Owen T. Carmichael
    Stroke. 2014;STROKEAHA.113.004084, originally published April 29, 2014
    https://doi.org/10.1161/STROKEAHA.113.004084

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
  • Article Alerts
    Log in to Email Alerts with your email address.
  • Save to my folders

Share this Article

  • Email

    Thank you for your interest in spreading the word on Stroke.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    White Matter Hyperintensities and Their Penumbra Lie Along a Continuum of Injury in the Aging Brain
    (Your Name) has sent you a message from Stroke
    (Your Name) thought you would like to see the Stroke web site.
  • Share on Social Media
    White Matter Hyperintensities and Their Penumbra Lie Along a Continuum of Injury in the Aging Brain
    Pauline Maillard, Evan Fletcher, Samuel N. Lockhart, Alexandra E. Roach, Bruce Reed, Dan Mungas, Charles DeCarli and Owen T. Carmichael
    Stroke. 2014;STROKEAHA.113.004084, originally published April 29, 2014
    https://doi.org/10.1161/STROKEAHA.113.004084
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo

Related Articles

Cited By...

Subjects

  • Imaging and Diagnostic Testing
    • Imaging
    • Computerized Tomography (CT)

Stroke

  • About Stroke
  • Instructions for Authors
  • Stroke CME
  • Guidelines and Statements
  • Meeting Abstracts
  • Permissions
  • Journal Policies
  • Email Alerts
  • Open Access Information
  • AHA Journals RSS
  • AHA Newsroom

Editorial Office Address:
200 5th Avenue
Suite 1020
Waltham, MA 02451
email: stroke@strokeahajournal.org

Information for:
  • Advertisers
  • Subscribers
  • Subscriber Help
  • Institutions / Librarians
  • Institutional Subscriptions FAQ
  • International Users
American Heart Association Learn and Live
National Center
7272 Greenville Ave.
Dallas, TX 75231

Customer Service

  • 1-800-AHA-USA-1
  • 1-800-242-8721
  • Local Info
  • Contact Us

About Us

Our mission is to build healthier lives, free of cardiovascular diseases and stroke. That single purpose drives all we do. The need for our work is beyond question. Find Out More about the American Heart Association

  • Careers
  • SHOP
  • Latest Heart and Stroke News
  • AHA/ASA Media Newsroom

Our Sites

  • American Heart Association
  • American Stroke Association
  • For Professionals
  • More Sites

Take Action

  • Advocate
  • Donate
  • Planned Giving
  • Volunteer

Online Communities

  • AFib Support
  • Garden Community
  • Patient Support Network
  • Professional Online Network

Follow Us:

  • Follow Circulation on Twitter
  • Visit Circulation on Facebook
  • Follow Circulation on Google Plus
  • Follow Circulation on Instagram
  • Follow Circulation on Pinterest
  • Follow Circulation on YouTube
  • Rss Feeds
  • Privacy Policy
  • Copyright
  • Ethics Policy
  • Conflict of Interest Policy
  • Linking Policy
  • Diversity
  • Careers

©2018 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. The American Heart Association is a qualified 501(c)(3) tax-exempt organization.
*Red Dress™ DHHS, Go Red™ AHA; National Wear Red Day ® is a registered trademark.

  • PUTTING PATIENTS FIRST National Health Council Standards of Excellence Certification Program
  • BBB Accredited Charity
  • Comodo Secured