Volume 25, Issue 111, May, 2021

Detectability of cerebral chronic white matter microangiopathy on CT compared to MRI: A teleradiology study

Amr M Ajlan^1,2, Ayman A Eskander^2,3, Turki A Alhazmi^2,3, Nahla Khamis Ibrahim^4,5♦, Ahmed Abduljabbar¹, Mohammad Wazzan¹, Khalid Khashoggi¹, Rani Ahmad¹, Ayman Esmaeil Elkashty⁶

¹Radiology Department, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
²Diagnostics Elite Teleradiology Company, Jeddah, Saudi Arabia
³Department of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
⁴Community Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
⁵Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
⁶Radiology Department, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia

^♦Corresponding author
Professor of Epidemiology at Community Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

ABSTRACT

Background: Cerebral chronic white matter (WM) microangiopathy is common with ageing and vasculopathy. It is known to be better detected on magnetic resonance imaging (MRI) compared to computed tomography (CT). Objective: To determine the detectability of WM microangiopathy on CT compared to MRI; utilizing a subjective visual approach. Material and Methods: A retrospective chart review was done in a private Jeddah’s hospital during 2020/2021. Four months of a local teleradiology practice archive was assessed for patients more than 40 years old who underwent both MRI and CT simultaneously. Those with known acute or other WM non-macroangiopathic findings were excluded. Detectability, size and location of supratentorial chronic WM changes were recorded for MRI and CT, considering MRI as the gold standard. Locations were categorized as periventricular, deep, juxtacortical and combination of all regions. Variable degrees of concordance between MRI and CT were assessed. Statistics were expressed in frequency distributions and mean +/-standard deviation. Comparison of categorical data by Fisher’s exact tests and between means by Mann Whitney U non-parametric test were performed (i.e., significant if P- values < 0.05). Results: A total of 35 cases were studied (62.9% males; mean age 40 ± 4.6 years). WM changes were present in 77.1% on MRI and 45.7% on CT. MRI WM changes were seen in all WM locations in 34.3% and in a juxtacortical site in 20%. CT WM changes were seen in all WM locations in 20%, and in 8.6% in each of deep and in juxtacortical WM in 8.6% locations. MRI and CT complete concordance were noted in 31.4% of cases. In 20% of cases, MRI changes were more severe. Discordance was partial and 17 1% and complete and 31.4% of cases. Smaller lesions were missed more commonly CT, primarily were located in the juxtacortical region. Conclusion: Subjective visual approach for detection of WM microangiopathy is more reliable on MRI compared to CT imaging, despite CT ability in detecting such changes and a reasonable number of cases. The most challenging location to identify chronic WM microangiopathy on CT is juxtacortical, especially with smaller lesions. Such knowledge has therapeutic and prognostic applications and serves as the basis for future studies.

Keywords: Chronic white matter microangiopathy, small vessel disease, computed tomography, magnetic resonance imaging, FLAIR

Medical Science, 2021, 25(111), 1044-1051

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