Distinguishing silent lacunar infarction from enlarged Virchow-Robin spaces: a magnetic resonance imaging and pathological study
Distinguishing silent lacunar infarction from enlarged Virchow-Robin spaces: a magnetic resonance imaging and pathological study
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DOI：
10.1007/s004150050189
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发表时间：
1998-02-01
影响因子：
6
通讯作者：
Yamaguchi, S
中科院分区：
文献类型：
--
作者：
Bokura, H;Kobayashi, S;Yamaguchi, S
我们研究了12例患者死后脑的磁共振成像(MRI)表现与病理结果之间的临床病理相关性，以确定区分腔隙梗塞和扩大的Virchow-Robin间隙的简单标准。12名患者中有6名也接受了活体MRI检查。我们的重点是小的，沉默的，局灶性病变，包括腔隙梗死和扩大的Virchow-Robin间隙，这些都是经病理证实的。在114个病灶中，扩大的Virchow-Robin间隙最常见于基底节，呈圆形或线形。腔隙梗死也最常见于基底节，但其中47%为楔形。在病理检查中，排除基底节下部的病变，扩大的Virchow-Robin间隙通常小于2×1 mm。MRI(活体和死后)确定的病变的形状和大小与病理结果一致，但MRI上的病变似乎比病理研究中发现的大约1 mm。当排除下基底节和脑干区的病变时，在病理学研究中，当扩大的Virchow-Robin间隙和腔隙梗塞的面积分别为2x1 mm或更小(分别为79%/75%)、2x2 mm或更小时(尸检(81%/90%))和体内(86%/91%)时，区分扩大的Virchow-Robin间隙和腔隙梗塞的敏感性和特异性最好。总而言之。根据腔隙梗塞的位置、形状和大小，我们能够在MRI上区分大多数腔隙梗塞和扩大的Virchow-Robin间隙。我们强调，大小是用于在MRI上区分这些病变的最重要的因素。
We studied clinicopathological correlations between magnetic resonance imaging (MRI) appearances of postmortem brains and pathological findings in 12 patients to identify simple criteria with which to distinguish lacunar infarctions from enlarged Virchow-Robin spaces. In vivo MRI was also available for 6 of the 12 patients. We focused on small, silent, focal lesions including lacunar infarctions and enlarged Virchow-Robin spaces that were confirmed pathologically. From a total of 114 lesions, enlarged Virchow-Robin spaces were most often found in the basal ganglia and had a round or linear shape. Lacunar infarctions also were most frequent in the basal ganglia, but 47% of these were wedge-shaped. In the pathological studies, excluding lesions from the lower basal ganglia region, enlarged Virchow-Robin spaces were usually smaller than 2 x 1 mm. The shapes and sizes of the lesions determined by MRI (in vivo and postmortem) concurred with the pathological findings, except that on MRI the lesions appeared to be about 1 mm larger than found in the pathological study. When lesions from the lower basal ganglia and the brain stem regions are excluded, the sensitivity and specificity for discriminating enlarged Virchow-Robin spaces from lacunar infarctions are optimal when their size is 2 x 1 mm or less in the pathological study (79%/75%, respectively), 2 x 2 mm or less in both of the MRI studies: postmortem (81%/90%), and in vivo (86%/91%). In conclusion. we were able to differentiate most lacunar infarctions from enlarged Virchow-Robin spaces on MRI on the basis of their location, shape and size. We stress that size is the most important factor used to discriminate these lesions on MRI.