Stroke Unit, Department of Neurology, Monash Medical Centre, Melbourne, Vic., Australia.
Cerebrovasc Dis. 2013;35(3):262-7. doi: 10.1159/000348310. Epub 2013 Mar 26.
It has been described that lacunar infarct is characterized by its smallish size (15-20 mm) in the axial plane. However, the size of the basal ganglia artery responsible for this type of infarct is uncertain. Detection of small arterial occlusion is not possible with current angiography, hindering correlation of arterial occlusion with subcortical infarct size. Recently, investigators have published microangiographic templates of arteries supplying the basal ganglia. These templates display first-order (proximal) to third-order (distal) branching of these arteries and can help with estimating the likely site of arterial disease in subcortical infarcts. We correlated the dimensions of subcortical infarcts with the order of arterial branching described in a microangiographic template. Such data may provide further clues about the type of arteries associated with subcortical infarcts and assist in refining the concept of lacunar infarction.
Patients with subcortical infarcts on MR imaging (MRI) admitted to our institution between 2009 and 2011 were included in the study. Infarcts were manually segmented and registered to a standard brain template. These segmented infarcts were scaled and overlapped with published microangiographic templates, and used by 6 raters who independently estimated the branching order of arterial disease that might result in these infarcts. We used regression analysis to relate these ratings to infarct dimensions.
Among 777 patients, there were 33 (58% male) patients with subcortical infarcts. The mean age was 63.1 ± 15.1 years. Infarct dimensions for the groups were as follows: group 1 (first-order branch): height 37.6 ± 7.4 mm, horizontal width 21.2 ± 11.6 mm, anterior-posterior length 36.8 ± 20.1 mm; group 2 (second-order branch): height 25.2 ± 7.9 mm, horizontal width 16.6 ± 22.8 mm, anterior-posterior length 16.1 ± 8.0 mm; group 3 (third-order branch): height 11.6 ± 5.7 mm, axial width 5.3 ± 3.1 mm, anterior-posterior length 5.5 ± 3.8 mm. Increasing vessel branching order (from large to small vessels) was linearly and negatively associated with infarct height (β = -16.7 mm per change in branching order disease, 95% CI -20.3, -13.1 mm, p < 0.01) and anterior-posterior length (β = -16.8 mm per change in branching order disease, 95% CI -23.2, -10.5 mm, p < 0.01).
Based on MRI infarct dimensions and a microangiographic template, it may be possible to estimate the branching order of the artery involved in subcortical infarcts. Further, our small data set suggests that reliance on an axial dimension of 15-20 mm may not be the best approach to classifying lacunar infarct. This finding needs to be confirmed in a larger data set.
已有研究表明腔隙性梗死的特征为其在轴位上的小尺寸（15-20mm）。然而，导致这种类型梗死的基底节动脉的大小尚不确定。目前的血管造影技术无法检测到小的动脉闭塞，这阻碍了动脉闭塞与皮质下梗死大小的相关性。最近，研究人员发表了供应基底节动脉的微血管造影模板。这些模板显示了这些动脉的一级（近端）到三级（远端）分支，可以帮助估计皮质下梗死中动脉疾病的可能部位。我们将皮质下梗死的尺寸与微血管造影模板中描述的动脉分支顺序进行了相关性分析。这些数据可能为与皮质下梗死相关的动脉类型提供进一步的线索，并有助于完善腔隙性梗死的概念。
我们纳入了 2009 年至 2011 年间在我院因皮质下梗死行磁共振成像（MRI）检查的患者。使用手动分割和将梗死灶配准到标准脑模板的方法对梗死灶进行分割。对这些分割后的梗死灶进行缩放，并与发表的微血管造影模板重叠，然后由 6 名评估者独立估计可能导致这些梗死灶的动脉疾病的分支顺序。我们使用回归分析将这些评分与梗死灶尺寸相关联。
在 777 例患者中，有 33 例（58%为男性）皮质下梗死患者。平均年龄为 63.1±15.1 岁。各组的梗死灶尺寸如下：第 1 组（一级分支）：高度 37.6±7.4mm，水平宽度 21.2±11.6mm，前后长度 36.8±20.1mm；第 2 组（二级分支）：高度 25.2±7.9mm，水平宽度 16.6±22.8mm，前后长度 16.1±8.0mm；第 3 组（三级分支）：高度 11.6±5.7mm，轴向宽度 5.3±3.1mm，前后长度 5.5±3.8mm。血管分支顺序（从大到小血管）的增加与梗死灶高度（分支顺序疾病每改变 16.7mm，β=-16.7mm，95%CI-20.3，-13.1mm，p<0.01）和前后长度（分支顺序疾病每改变 16.8mm，β=-16.8mm，95%CI-23.2，-10.5mm，p<0.01）呈线性负相关。
根据 MRI 梗死灶的尺寸和微血管造影模板，可能可以估计参与皮质下梗死的动脉的分支顺序。此外，我们的小数据集表明，依赖 15-20mm 的轴位尺寸可能不是腔隙性梗死分类的最佳方法。这一发现需要在更大的数据集上得到证实。
