MULTIFOCAL HYPOINTENSE CEREBRAL-LESIONS ON GRADIENT-ECHO MR ARE ASSOCIATED WITH CHRONIC HYPERTENSION

PURPOSE: To investigate the basis for multifocal hypointense lesions w ithin the brain as identified on T2-weighted gradient-echo MR imaging in patients with no known or presumed cause of these lesions. METHODS : In the first of a two-part study design, we retrospectively reviewed a case series of 38 patients whose gradient-echo MR images showed mul tiple hypointense lesions within the brain parenchyma. Thirty-one case s in which the cause was known or presumed (eg, head trauma or caverno us angioma) were excluded from Further review, The MR studies and clin ical findings of the remaining seven cases were reexamined. In the sec ond part, using a cohort study design with respect to hypertension, we prospectively reviewed the gradient-echo images from MR studies of 65 patients and control subjects enrolled in two ongoing clinical studie s, one on ''possible vascular dementia'' (n=33) and the other on ''pos sible motor neuron disorder'' (n=32). RESULTS: In the first part of th e study, we found seven cases with a pattern of multiple hypointense l esions involving the deep gray matter nuclei, especially the basal gan glia (n=6) and thalamus (n=5). In addition, involvement of the corona radiata (n=5), brain stem (n=4), and cerebellum (n=3) was seen. Clinic al review revealed a history of chronic hypertension in all seven pati ents. In the cohort study, we found three of 65 persons who had two or more focal hypointense lesions that involved the basal ganglia or tha lami. Review of the clinical data showed that all three patients were being treated for hypertension; also, all three were patients from the ''possible vascular dementia'' group, CONCLUSIONS: The MR imaging pat tern of multifocal hypointense lesions within the basal ganglia, thala mus, and other deep cerebral structures is more commonly Found among p atients with a history of chronic hypertension than in patients withou t chronic hypertension.