Diffusion-weighted magnetic resonance imaging in symptomatic vertebrobasilar atherosclerosis and dissection
Diffusion-weighted magnetic resonance imaging in symptomatic vertebrobasilar atherosclerosis and dissection
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DOI：
10.1001/archneur.62.8.1228
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发表时间：
2005-08-01
影响因子：
--
通讯作者：
Forteza, A
中科院分区：
文献类型：
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作者：
Koch, S;Amir, M;Forteza, A
背景资料：急性多发性脑梗死（AMBI）的弥散加权成像（DWI）模式与动脉和心脏栓塞源有关。由于椎基底动脉夹层和动脉粥样硬化性疾病导致卒中患者的DWI特征尚未详细报道。目的：描述后循环闭塞性疾病患者的DWI卒中模式，以确定缺血机制。设计：回顾性分析有症状椎基底动脉疾病患者的梗死模式。地点：大型社区教学医院。患者：回顾性地确定了因椎基底动脉疾病而住院的卒中患者。如果DWI是在7天内获得症状onset.Main结果Measure的患者包括在内：螺旋CT模式进行了分析，根据建立模板的血管territors.Results：11例椎动脉夹层和39例动脉粥样硬化血栓形成。11例动脉夹层患者中有8例（72%）存在AMBI模式，39例动脉粥样硬化性疾病患者中有25例（64%）存在AMBI模式（P= 0.48）。两组中基底动脉末端分支的远端栓塞发生频率相同，并且在所有病例中发现了一半。未发生孤立性丘脑梗死。11例夹层患者中有2例（18%）发生脑桥梗死，39例动脉粥样硬化患者中有18例（46%）发生脑桥梗死（P= 0.09）。39例动脉粥样硬化患者中14例（36%）小脑边缘区受累，11例夹层患者中4例（37%）小脑边缘区受累（P = 0.6）。AMBI的发生率与前循环中报告的发生率相当。DWI研究支持栓塞作为椎基底动脉闭塞性疾病患者梗死的主要机制的重要性。根据我们的经验，大血管椎基底动脉疾病很少引起孤立性小血管丘脑梗死。
Background: Acute multiple brain infarction (AMBI) pattern on diffusion-weighted imaging (DWI) is associated with arterial and cardiac sources of embolism. The DWI characteristics of patients with stroke due to vertebrobasilar arterial dissection and atherosclerotic disease have not been reported in detail.Objective: To describe the DWI stroke patterns in patients with posterior circulation occlusive disease to determine mechanisms of ischemia.Design: Retrospective analysis of infarct patterns in patients with symptomatic vertebrobasilar disease.Setting: Large community-based teaching hospital.Patients: Patients admitted with stroke due to vertebrobasilar disease were identified retrospectively. Patients were included if DWI was obtained within 7 days of symptom onset.Main Outcome Measure: Infarct patterns were analyzed according to established templates of vascular territories.Results: Eleven patients with vertebral dissection and 39 patients with atherothrombosis were identified. An AMBI pattern was present in 8 (72%) of 11 patients with arterial dissections and 25 (64%) of 39 patients with atherosclerotic disease (P=.48). Distal embolism to the terminal branches of the basilar artery occurred with equal frequency in both groups and was found in half of all cases. Isolated thalamic infarction did not occur. Pontine infarction was noted in 2 (18%) of 11 patients with dissections and 18 (46%) of 39 patients with atherosclerosis (P=.09). Cerebellar border zone involvement was found in 14 (36%) of 39 patients with atherosclerosis and 4 (3 7%) of 11 patients with dissections (P =.6).Conclusions: Large arterial disease is frequently associated with AMBI in the posterior circulation. The incidence of AMBI was comparable to that reported in the anterior circulation. This DWI study supports the importance of embolism as the main mechanism of infarction in patients with vertebrobasilar occlusive disease. On the basis of our experience, large-vessel vertebrobasilar disease rarely causes isolated small-vessel thalamic infarction.