Infarct Size May Distinguish the Pathogenesis of Lacunar Infarction of the Middle Cerebral Artery Territory.
Infarct Size May Distinguish the Pathogenesis of Lacunar Infarction of the Middle Cerebral Artery Territory.
复制标题
梗塞大小可区分大脑中动脉区腔隙性梗塞的发病机制
DOI：
10.12659/msm.896898
复制
发表时间：
2016-01-20
期刊：
影响因子：
--
通讯作者：
Hu W
中科院分区：
文献类型：
--
作者：
Yang L;Qin W;Zhang X;Li Y;Gu H;Hu W
腔隙性梗死是由小血管疾病（SVD）和分支动脉粥样硬化疾病（BAD）引起的。腔隙性梗死根据其在大脑中动脉（MCA）范围内的位置可分为近端血管腔隙性梗死（BAD）和远端血管腔隙性梗死（SVD）。研究发现，透镜状纹状动脉可能以不同的方式存在，腔隙梗死的大小可能与分支顺序有关。我们研究腔隙性梗死的大小是否能在MCA正常患者中区分SVD和BAD。材料/方法我们回顾性研究312例腔隙性梗死患者，mri血管造影显示MCA正常。我们在MR t2加权图像上发现了MCA的正常流动空洞，DWI上认为同一层为0级。以梗死灶最低层的中位数和病灶大小的平均值为分界点。根据腔隙性梗死的切点位置和大小分为两组。两组间比较的资料包括临床资料、影像学资料和美国国立卫生研究院卒中量表评分。结果312例患者中，梗死灶最低层中位数为第3层。与BAD患者相比，从梗死部位来看，SVD患者年龄较大，有高血压和吸烟史的患者较多，白质变严重，梗死灶较小。DWI图像上病灶平均长度为11.1 mm。根据梗死面积，SVD患者入院时NIHSS评分较低。FLAIR图像上病灶平均高度为12.26 mm。SVD患者多为男性，吸烟患病率较高，入院时白质病变较严重，NIHSS评分较低。DWI和FLAIR图像上腔隙梗死直径与梗死最下层病变水平呈负相关。结论脑梗死灶大小可作为区分腔隙性脑梗死伴MCA正常的SVD和BAD的一种方法。
Background Lacunar infarctions are caused by small vessel disease (SVD) and branch atheromatous disease (BAD). Lacunar infarction may be classified as proximal vessel lacunar infarction (BAD) or distal vessel lacunar infarction (SVD) according to its location within the middle cerebral artery (MCA) territory in patients with normal MCA. Studies found that the lenticulostriate arteries may exist different ways and that the size of lacunar infarction may be dependent on the branching order. We investigated whether lacunar infarction size can differentiate between SVD and BAD in patients with normal MCA. Material/Methods We retrospectively studied 312 patients with lacunar infarction who had normal MCA on MR angiography. We found the normal flow void of the MCA on MR T2-weighted images, and the same layer on DWI was considered the level 0. The median of lowest layer of infarction lesions and the mean of lesion size were considered the cutoff point. We divided lacunar infarction into 2 groups according to cutoff point of lesion location and size. Data compared between the 2 groups included clinical information, radiography, and National Institutes of Health Stroke Scale score. Results Of all the 312 patients, the median of lowest layer of infarction lesions was the 3rd level. Compared to patients with BAD, according to infarct location, patients with SVD were older, more often had a history of hypertension and smoking, and had more severe leukoaraiosis and smaller infarct lesions. The mean length of lesions was 11.1 mm on DWI images. Patients with SVD, according to infarct size, had lower NIHSS scores at admission. The mean lesion height was 12.26 mm on FLAIR images. Patients with SVD were more often male, had higher prevalence of smoking, and had more severe leukoaraiosis and lower NIHSS scores at admission. The lacunar infarction diameter on DWI and FLAIR images was negatively correlated with the level of lowest layer of infarction lesions. Conclusions Our data suggest that infarct lesion size may be used as a method to distinguish SVD and BAD in lacunar infarction patients with normal MCA.