Estimating Total Cerebral Microinfarct Burden From Diffusion-Weighted Imaging.
Estimating Total Cerebral Microinfarct Burden From Diffusion-Weighted Imaging.
复制标题
通过弥散加权成像估计脑微梗塞总负担。
DOI：
10.1161/strokeaha.115.009208
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发表时间：
2015-08
期刊：
影响因子：
8.3
通讯作者：
Greenberg SM
中科院分区：
文献类型：
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作者：
Auriel E;Westover MB;Bianchi MT;Reijmer Y;Martinez-Ramirez S;Ni J;Van Etten E;Frosch MP;Fotiadis P;Schwab K;Vashkevich A;Boulouis G;Younger AP;Johnson KA;Sperling RA;Hedden T;Gurol ME;Viswanathan A;Greenberg SM
脑微梗死（CMI）是血管性认知功能障碍的重要因素。MRI弥散加权成像（DWI）高信号被认为是急性CMI的代表。我们的目的是描述一种数学方法来估计的基础上存在的偶发DWI病变的CMI总数。我们回顾了认知功能下降、认知功能正常和既往脑出血患者的MRI扫描。基于DWI病变的时间和空间特征，我们估计了用于解释每组中观察到的DWI病变检出率所需的CMI年发生率。为了证实我们的估计，我们在一名患有脑叶ICH的死亡受试者的大脑中进行了广泛的CMI采样，该受试者在生前发现有DWI病变。343例认知功能受损患者中有13例（3.8%）存在临床无症状DWI病变，199例认知功能正常的非ICH患者中有10例（5%）存在临床无症状DWI病变，均低于既往ICH患者的发生率（23/178，12.9%，p<0.0006）。非ICH患者CMI的预测年发病率范围为16 - 1566，ICH患者为50 - 5041。组织学取样显示32个切片中共有60处病变。基于先前报告的方法，该CMI密度产生的估计总脑负荷MLE为9321 CMI（95% CI 7255-11990）。即使检测到单个DWI病变，也表明每年发生数百例新的CMI。这些病变的累积效应可能直接导致小血管相关的血管性认知障碍
Cerebral microinfarcts (CMI) are important contributors to vascular cognitive impairment. MRI diffusion-weighted imaging (DWI) hyperintensities have been suggested to represent acute CMI. We aim to describe a mathematical method for estimating total number of CMI based on the presence of incidental DWI lesions. We reviewed MRI scans of subjects with cognitive decline, cognitively normal subjects and previously reported subjects with past intracerebral hemorrhage (ICH). Based on temporal and spatial characteristics of DWI lesions we estimated the annual rate of CMI needed to explain the observed rate of DWI lesion detection in each group. To confirm our estimates we performed extensive sampling for CMI in the brain of a deceased subject with past lobar ICH who found to have a DWI lesion during life. Clinically silent DWI lesions were present in 13 of 343 (3.8%) cognitively impaired, and 10 of 199 (5%) cognitively intact normal non-ICH patients, both lower than the incidence in the past ICH patients (23 of 178, 12.9%, p<0.0006). The predicted annual incidence of CMI ranges from 16 to 1566 for non-ICH and 50 to 5041 for ICH individuals. Histologic sampling revealed a total of 60 lesions in 32 sections. Based on previously reported methods, this density of CMI yields an estimated total brain burden MLE of 9321 CMIs (95% CI 7255–11990). Detecting even a single DWI lesion suggests an annual incidence of hundreds of new CMI. The cumulative effects of these lesions may directly contribute to small-vessel-related vascular cognitive impairment