The Volume of Lacunes
2001; Lippincott Williams & Wilkins; Volume: 32; Issue: 8 Linguagem: Inglês
10.1161/01.str.32.8.1937
ISSN1524-4628
AutoresRichard Gerraty, Mark Parsons, P. Alan Barber, David Darby, Stephen M. Davis,
Tópico(s)Prenatal Screening and Diagnostics
ResumoHomeStrokeVol. 32, No. 8The Volume of Lacunes Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBThe Volume of Lacunes Richard P. Gerraty, Mark W. Parsons, P. Alan Barber, David G. Darby and Stephen M. Davis Richard P. GerratyRichard P. Gerraty For the Royal Melbourne Echoplanar Imaging in Stroke Study Group, Melbourne Neuroscience Centre, Royal Melbourne Hospital, Parkville, Australia , Mark W. ParsonsMark W. Parsons For the Royal Melbourne Echoplanar Imaging in Stroke Study Group, Melbourne Neuroscience Centre, Royal Melbourne Hospital, Parkville, Australia , P. Alan BarberP. Alan Barber For the Royal Melbourne Echoplanar Imaging in Stroke Study Group, Melbourne Neuroscience Centre, Royal Melbourne Hospital, Parkville, Australia , David G. DarbyDavid G. Darby For the Royal Melbourne Echoplanar Imaging in Stroke Study Group, Melbourne Neuroscience Centre, Royal Melbourne Hospital, Parkville, Australia and Stephen M. DavisStephen M. Davis For the Royal Melbourne Echoplanar Imaging in Stroke Study Group, Melbourne Neuroscience Centre, Royal Melbourne Hospital, Parkville, Australia Originally published1 Aug 2001https://doi.org/10.1161/01.STR.32.8.1937Stroke. 2001;32:1937–1938To the Editor:With the insight on stroke mechanisms provided by volume measurements of diffusion and perfusion MRI lesions,1,2 it may be time to reassess the dimensions of a lacune. Whether lenticulostriate infarcts as large as 15 mm are commonly due to single perforator occlusion,3 or whether they are more likely to be limited striatocapsular infarcts due to middle cerebral artery embolism4 could be explored by prospective studies with MRI.The upper limit of the size of a lacune was for a long time recorded in terms of diameter and was set at 15 mm, with most being 2, 3, or 4 mm.5 Fisher called lacunes greater than 10 mm in diameter "giant lacunes." In the classification of subcortical infarction proposed in 1993,3 a lacune was defined as an infarct <1.5 cm (15 mm) in diameter, likely to be due to occlusion of a single perforating artery. Most lacunes are much smaller than 15 mm in diameter. In one recent MRI study, the average lacune volume was 0.5 mL (500 mm3), indicating a diameter of ≈10 mm.6In this light, it is perplexing to see regularly in print, in Stroke and elsewhere, that the upper limit of the size of a lacune is 15 mm3.7–11 The volume of a cube with sides 15 mm is not 15 mm3 but 15×15×15=3375 mm3. If a particular lacune is spherical, then by the formula for the volume of a sphere, v=4/3πr,3 the volume of a lacune 15 mm in diameter is 1767 mm3. The figures look less impressive if one does the calculation for the same volume in cubic centimeters: diameter 1.5 cm, volume 1.767 cm3. A lacune of 15 mm3 would not be large at all, having a diameter of ≈3 mm. Lacunes may not be spherical, of course,5 and in an important review in Stroke7 the size was recorded as "4×4×5 mm" for one lesion. Such a lesion, even if spheroidal, would have a volume at least twice 15 mm3, but it was in that review that the upper limit of the size of a lacune was stated as "15 cu mm." The reference cited for this referred to the size only in terms of diameter, the upper limit being 15 mm.5 In a recent leading textbook chapter on lacunes, the upper limit of 15 mm3 is discussed in particular reference to the notion of giant or super lacunes.10There is no justification for setting the limit of the volume of a lacune at 15 mm3. This must be an error that has been repeated at times in the literature and in reputable textbooks. The error is not explained in terms of mistaking the powers of 10 involved in volume calculations with millimeters versus centimeters, nor is it explained by mistaking the nature of volume calculations from length measures. Probably a single transposition error from diameter to volume occurred at some point, perhaps in 1982, and this error has been quoted often enough that it has become entrenched in some quarters.1 Barber PA, Darby DG, Desmond PM, Yang Q, Gerraty RP, Jolley D, Donnan GA, Tress BM, Davis SM. Prediction of stroke outcome with echoplanar perfusion- and diffusion-weighted MRI. Neurology. 1998; 51: 418–426.CrossrefMedlineGoogle Scholar2 Darby DG, Barber PA, Gerraty RP, Desmond PM, Yang Q, Parsons M, Li T, Tress BM, Davis SM. Pathophysiological topography of acute ischemia by combined diffusion-weighted and perfusion MRI. Stroke. 1999; 30: 2043–2052.CrossrefMedlineGoogle Scholar3 Donnan GA, Norrving B, Bamford JM, Bogousslavsky J. Subcortical infarction: classification and terminology. Cerebrovasc Dis. 1993; 3: 248–251.CrossrefGoogle Scholar4 Ringelstein EB, Biniek R, Weiller C, Ammeling B, Nolte PE, Thron A. Type and extent of hemispheric brain infarctions and clinical outcome in early and delayed middle cerebral artery recanalization. Neurology. 1992; 42: 289–298.CrossrefMedlineGoogle Scholar5 Fisher CM. Lacunes. small, deep cerebral infarcts. Neurology. 1965; 15: 774–784.CrossrefMedlineGoogle Scholar6 Lindgren A, Staaf G, Geijer B, Brockstedt S, Stahlberg F, Holtas S, Norrving B. Clinical lacunar syndromes as predictors of lacunar infarcts: a comparison of acute clinical lacunar syndromes and findings on diffusion-weighted MRI. Acta Neurol Scand. 2000; 101: 128–134.CrossrefMedlineGoogle Scholar7 Mohr JP. Lacunes. Stroke. 1982; 13: 3–11.CrossrefMedlineGoogle Scholar8 Mohr JP. Lacunes.In: Barnett HJM, Mohr JP, Stein BM, Yatsu FM, eds. Stroke: Pathophysiology, Diagnosis, and Management. 2nd ed. New York, NY: Churchill Livingstone; 1992:539–560.Google Scholar9 Minematsu K. Lacunar stroke.In: Fisher M, ed. Clinical Atlas of Cerebrovascular Disorders. London, UK: Wolfe; 1994: 8: 1–8.17.Google Scholar10 Mohr JP, Marti-Vilalta J-L. Lacunes.In: Barnett HJM, Mohr JP, Stein BM, Yatsu FM, eds. Stroke: Pathophysiology, Diagnosis, and Management. 3rd ed. New York, NY: Churchill Livingstone; 1998:599–622.Google Scholar11 Ay H, Oliveira-Filho J, Buonanno FS, Ezzeddine M, Schaefer PW, Rordorf G, Schwamm LH, Gonzalez RG, Koroshetz WJ. Diffusion-weighted imaging identifies a subset of lacunar infarction associated with embolic source. Stroke. 1999; 30: 2644–2650.CrossrefMedlineGoogle Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Rudilosso S, Urra X, San Román L, Laredo C, López-Rueda A, Amaro S, Oleaga L and Chamorro Á (2015) Perfusion Deficits and Mismatch in Patients with Acute Lacunar Infarcts Studied with Whole-Brain CT Perfusion, American Journal of Neuroradiology, 10.3174/ajnr.A4303, 36:8, (1407-1412), Online publication date: 1-Aug-2015. Rodríguez García P and Rodríguez García D (2015) Diagnóstico del deterioro cognitivo vascular y sus principales categorías, Neurología, 10.1016/j.nrl.2011.12.014, 30:4, (223-239), Online publication date: 1-May-2015. Price C, Tanner J, Schmalfuss I, Garvan C, Gearen P, Dickey D, Heilman K, McDonagh D, Libon D, Leonard C, Bowers D and Monk T (2014) A Pilot Study Evaluating Presurgery Neuroanatomical Biomarkers for Postoperative Cognitive Decline after Total Knee Arthroplasty in Older Adults, Anesthesiology, 10.1097/ALN.0000000000000080, 120:3, (601-613), Online publication date: 1-Mar-2014. Bal S, Goyal M, Smith E and Demchuk A (2014) Central nervous system imaging in diabetic cerebrovascular diseases and white matter hyperintensities Diabetes and the Nervous System, 10.1016/B978-0-444-53480-4.00021-7, (291-315), . Lin L, Bivard A and Parsons M (2013) Perfusion Patterns of Ischemic Stroke on Computed Tomography Perfusion, Journal of Stroke, 10.5853/jos.2013.15.3.164, 15:3, (164), . Phan T, van der Voort S, Beare R, Ma H, Clissold B, Holt M, Ly J, Foster E, Thong E, Stuckey S, Cassell M and Srikanth V (2013) Dimensions of Subcortical Infarcts Associated with First- to Third-Order Branches of the Basal Ganglia Arteries, Cerebrovascular Diseases, 10.1159/000348310, 35:3, (262-267), . August 2001Vol 32, Issue 8 Advertisement Article InformationMetrics https://doi.org/10.1161/01.STR.32.8.1937 Originally publishedAugust 1, 2001 PDF download Advertisement
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