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Background and Purpose—  Incidental magnetic resonance diffusion-weighted imaging (DWI)–positive lesions, considered to represent small acute infarcts, have been detected in patients with cerebral small vessel diseases or cognitive impairment, but the prevalence in the community population is unknown.    Methods—  DWI sequences collected in 793 participants in the Prospective Urban Rural Epidemiological (PURE) study were reviewed for DWI lesions consistent with small acute infarcts.    Results—  No DWI-positive lesions were detected (0%, 95% confidence interval, 0–0.5).    Conclusions—  DWI-positive lesions are rare in an asymptomatic community population. The prevalence of DWI-positive lesions in the community seems to be lower than in patients with cerebral amyloid angiopathy, intracerebral hemorrhage, or cognitive impairment.

Incidental Magnetic Resonance Diffusion-Weighted Imaging–Positive Lesions Are Rare in Neurologically Asymptomatic Community-Dwelling Adults