Age-related White Matter Changes

MR FLAIR images show multiple FLAIR hyperintense foci in bilateral periventricular and deep white matter in a 77-year-old patient.

Facts:

• Several possible mechanisms but at present it is believed to be an incomplete ischemia mainly related to cerebral small vessel arteriolosclerosis
• Pathology: partial loss of myelin, axons, oligodendroglial cells; mild reactive gliosis, astrocytic gliosis, stenosis of arterioles from hyaline fibrosis
• Important substrates for cognitive impairment and functional loss in the elderly
• Very common in elderly with hypertension, diabetes, hyperlipidemai

Imaging

• Ill-defined hypodensities on CT
• T1 hypointensities, T2/PD/FLAIR hyperintensities. FLAIR best to demonstrate severity of disease
• When the largest lesion is adjacent to ventricles, it's called periventricular white matter changes
• On diffusion tensor MRI, there is elevation of diffusivity and reduced fractional anisotrophy (FA) meaning impaired white matter integrity

Reference:
Xiong YY, Mok V. Age-related white matter changes. J Aging Res 2011