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Domenico Maria Mezzapesa, MD; Maria Assunta Rocca, MD; Elisabetta Pagani, PhD; Giancarlo Comi, MD; Massimo Filippi, MD

Arch Neurol. 2003;60:1109-1112.

Objective  To investigate whether additional "occult" tissue changes can be detected in the normal-appearing white matter and gray matter of otherwise normal elderly individuals with nonspecific white-matter hyperintensities on conventional magnetic resonance images of the brain.

Methods  Conventional and magnetization transfer magnetic resonance images were obtained from 12 otherwise normal elderly subjects with white-matter hyperintensities and 11 age- and sex-matched normal individuals. After automatic tissue segmentation, image coregistration, and masking of T2-visible lesions, we obtained magnetization transfer ratio histograms of the normal-appearing white matter and gray matter. For each histogram, the average magnetization transfer ratio, the peak height, and the peak position were measured. We also calculated the percentages of gray-matter and white-matter volumes normalized over the total volume of the intracranial content and the total normalized brain volumes.

Results  Average magnetization transfer ratio (P = .03) and mean peak position (P = .01) of the gray-matter histograms from elderly individuals with white-matter hyperintensities were significantly lower than the corresponding quantities from those without white-matter hyperintensities. The normalized percentages of gray and white matter and normalized brain volume did not differ between the 2 groups. The average gray-matter magnetization transfer ratio was correlated with the average lesion magnetization transfer ratio (r = 0.68; P<.01).

Conclusions  This study shows that brain abnormalities in otherwise normal elderly subjects with nonspecific white-matter hyperintensities extend beyond the macroscopic white-matter lesions visualized on conventional magnetic resonance images.

From the Neuroimaging Research Unit, Department of Neurology (Drs Mezzapesa, Rocca, Pagani, and Filippi), and Department of Neurology (Dr Comi), Scientific Institute and University Ospedale San Raffaele, Milan, Italy.

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