Division of Neurology, University of Alberta, Edmonton, Alberta, Canada.
Stroke. 2011 Aug;42(8):2191-5. doi: 10.1161/STROKEAHA.110.611376. Epub 2011 Jul 7.
Transient ischemic attack and minor stroke are associated with high ischemic recurrence in the first week. We prospectively studied the correlation between baseline diffusion/perfusion deficits and development of new ischemic lesions.
Patients with transient ischemic attack and those with minor stroke (n=50) underwent MRI at admission. Acute perfusion-weighted imaging deficit (Tmax+2-second delay) and diffusion-weighted imaging (DWI) lesion volumes were measured planimetrically. Follow-up scans were examined for new DWI/fluid-attenuated inversion recovery lesions at Days 7 and 30.
Twenty-eight patients (56%) had acute DWI lesions. New DWI lesions developed in 9 of 50 patients (18%) at 1 week and 11 of 50 (cumulative 22%) at 4 weeks. Patients with new infarcts were more likely to have baseline DWI lesions (χ²=8.264, P=0.003). Baseline DWI lesion volume was significantly larger in those who developed new lesions at Day 7 (median, 13.2 mL; interquartile range, 12 versus median 0.1 mL; interquartile range, 2 mL; P<0.001) and Day 30 (11.1 mL; interquartile range, 13 mL versus 0.1 mL; interquartile range, 13 mL; P<0.001). Thirty-eight patients had baseline perfusion-weighted imaging. Patients with recurrent lesions were more likely to have baseline perfusion deficits (χ²=19.5, P<0.0001). All new lesions developed within the baseline hypoperfused regions. Baseline DWI lesion volume predicted new lesion development at day 7 (OR, 1.17 per mL; CI, 1.05 to 1.30; P=0.005) and Day 30 (OR, 1.39 per mL; CI, 1.03 to 1.26; P=0.009) by regression analysis.
Early recurrence of stroke is much more likely in patients with larger baseline DWI and perfusion-weighted imaging lesions. MRI lesion "recurrence" appears to be related to completion of the natural history of the original cerebrovascular syndrome rather than de novo events in most patients.
短暂性脑缺血发作和小卒中与第一周内的高缺血性复发相关。我们前瞻性研究了基线弥散/灌注缺损与新缺血性病变发展之间的相关性。
短暂性脑缺血发作和小卒中患者（n=50）入院时行 MRI 检查。通过平面测量法测量急性灌注加权成像（Tmax+2 秒延迟）和弥散加权成像（DWI）病灶容积。在第 7 天和第 30 天的随访扫描中，检查新的 DWI/液体衰减反转恢复（FLAIR）病灶。
28 例患者（56%）有急性 DWI 病灶。50 例患者中有 9 例（18%）在第 1 周和 11 例（累计 22%）在第 4 周时出现新的 DWI 病灶。出现新梗死的患者更有可能有基线 DWI 病灶（χ²=8.264，P=0.003）。在第 7 天（中位数 13.2 mL；四分位距 12 比中位数 0.1 mL；四分位距 2 mL；P<0.001）和第 30 天（中位数 11.1 mL；四分位距 13 mL 比中位数 0.1 mL；四分位距 13 mL；P<0.001）时，新发梗死患者的基线 DWI 病灶体积明显更大。38 例患者有基线灌注加权成像。出现复发性病变的患者更有可能有基线灌注缺损（χ²=19.5，P<0.0001）。所有新发病灶均发生在基线低灌注区域内。基线 DWI 病灶体积可预测第 7 天（OR，1.17 每毫升；CI，1.05 至 1.30；P=0.005）和第 30 天（OR，1.39 每毫升；CI，1.03 至 1.26；P=0.009）的新病灶发展。
基线 DWI 和灌注加权成像病灶较大的患者更有可能出现早期卒中复发。磁共振成像（MRI）病变的“复发”似乎与原始脑血管综合征的自然病程有关，而不是大多数患者的新发病例。
