Extent and Distribution of White Matter Hyperintensities in Stroke Patients: The Sydney Stroke Study

Background and Purpose— White matter hyperintensities (WMHs) on T2-weighted MRI are common in stroke patients and healthy elderly individuals. The detailed anatomical distribution of these lesions in stroke patients has not been examined. Methods— A total of 112 stroke or transient ischemic attack patients and 87 matched control subjects from the Sydney Stroke Study underwent MRI scans that included a T2-weighted fluid-attenuated inversion recovery (FLAIR) sequence. WMHs were delineated from each FLAIR MRI by an automated method. Region of interest and voxel-wise statistical parametric mapping approaches were applied to examine the volume, distribution, and severity of WMHs of the patient and control groups, and subgroups with large or lacunar infarcts. Results— Stroke subjects had significantly more WMHs than controls in all brain regions except the occipital lobe and in all arterial territories except the anterior callosal and anterior medial lenticulostriate. In the frontotemporal regions, average WMH volumes in patients were >3.5× those in controls. The total number of discrete WMHs was not different in the 2 groups, but stroke patients had more large (>20 mm) and high-intensity lesions. Subjects with lacunar infarcts had more WMHs than those with large infarcts, who, in turn, had more WMHs than control subjects. Lacunar infarction subjects had more WMHs than subjects with large thromboembolic or cardioembolic strokes. Those with anterior arterial territory infarction had more WMHs in the frontal regions. Subjects with single or multiple lacunes did not differ in volumes of WMHs. Conclusions— Stroke patients have significantly more WMHs in nearly every brain region than healthy controls. Those with lacunar infarcts are particularly affected. WMHs represent a significant proportion of the ischemic lesion burden in stroke and transient ischemic attack patients.