NeuroMar Research Group, Stroke Unit, Department of Neurology, Hospital del Mar-IMIM, Barcelona, Spain.
J Neurol. 2010 Jun;257(6):947-53. doi: 10.1007/s00415-009-5443-5. Epub 2010 Jan 3.
Brain ischemic lesions identified by diffusion-weighted imaging (DWI) have been shown to predict high risk of early future ischemic events in patients with transient ischemic attacks and minor stroke. The aim of this study is to analyze different brain MRI-DWI patterns in patients with mild-moderate stroke to define acute patterns related with a higher risk of stroke recurrence in long-term follow-up (from 6 to 36 months). Retrospective review of case series from a prospective stroke record including 253 patients with mild-moderate stroke (NIHSS from 1 to 7) and acute MRI-DWI lesions. MRI-DWI lesions were analyzed to determine clinically relevant lesions, based on the number, location, age and affected arterial territories. We defined three patterns: (1) multiple versus single lesions; (2) single deep versus single cortical lesions; and (3) single lesions versus multiple lesions affecting different arterial territories and/or of different age. The impact of these patterns on recurrence was analyzed by Cox regression analysis. 38 patients (15.0%) suffered a recurrence. Univariate analysis showed the risk of recurrence for each pattern. Pattern 1: patients with multiple lesions had greater risk of recurrence than those with single lesions (28.2 vs. 9.9%; OR: 3.75 (95% CI: 1.76-7.27), p < 0.0001). Pattern 2: patients with single cortical lesions had higher risk than those with deep lesions (14.3 vs. 6.7% OR: 2.33 (95% CI: 0.86-6.33), p < 0.089). Pattern 3: patients with multiple DWI in different territories or different age had the highest recurrence rate (30.6%), OR: 4.01 (95% CI: 1.70-9.47), p < 0.001, compared to patients with single lesions. Cox regression analysis adjusted by possible confounders, showed that for pattern 1 the OR for recurrence was 2.49 (95% CI: 1.27-4.89), p = 0.008; for pattern 2, OR:1.99 (95% CI: 0.74-5.37), p = 0.17; for pattern 3, OR: 2.85 (95% CI: 1.31-6.15), p = 0.008. Brain MRI-DWI patterns assessed in the acute phase of mild-moderate stroke are useful to identify those patients at high risk of recurrence.
弥散加权成像 (DWI) 识别的脑缺血性病变已被证明可预测短暂性脑缺血发作和小卒中患者未来早期发生缺血性事件的高风险。本研究的目的是分析轻度中度卒中患者不同的脑 MRI-DWI 模式，以确定与长期随访（6 至 36 个月）中更高卒中复发风险相关的急性模式。对包括 253 例轻度中度卒中患者（NIHSS 评分 1 至 7）的前瞻性卒中记录的病例系列进行回顾性分析。MRI-DWI 病变的分析是基于数量、位置、年龄和受影响的动脉区域来确定有临床意义的病变。我们定义了三种模式：（1）多发与单发病变；（2）单发深部与单发皮质病变；（3）单发病变与多发病变，影响不同的动脉区域和/或不同的年龄。通过 Cox 回归分析来分析这些模式对复发的影响。38 例（15.0%）患者发生复发。单因素分析显示了每种模式的复发风险。模式 1：多发病变患者的复发风险高于单发病变患者（28.2%比 9.9%；OR：3.75（95%CI：1.76-7.27），p <0.0001）。模式 2：单发皮质病变患者的复发风险高于深部病变患者（14.3%比 6.7%；OR：2.33（95%CI：0.86-6.33），p <0.089）。模式 3：在不同部位或不同年龄有多发性 DWI 的患者复发率最高（30.6%），OR：4.01（95%CI：1.70-9.47），p <0.001，与单发病变患者相比。通过可能的混杂因素进行 Cox 回归分析后，对于模式 1，复发的 OR 为 2.49（95%CI：1.27-4.89），p=0.008；对于模式 2，OR：1.99（95%CI：0.74-5.37），p=0.17；对于模式 3，OR：2.85（95%CI：1.31-6.15），p=0.008。轻度中度卒中急性期的脑 MRI-DWI 模式有助于识别复发风险较高的患者。
