主动脉源性栓塞性卒中的脑磁共振成像扩散加权图像特征。

Features of brain magnetic resonance imaging diffusion-weighted images of aortogenic embolic stroke.

作者信息

Shimada Jun-Ichiro, Yasaka Masahiro, Wakugawa Yoshiyuki, Ogata Toshiyasu, Makihara Noriko, Ito Shoichi, Kuwabara Satoshi, Okada Yasushi

机构信息

Department of Cerebrovascular Medicine and Neurology, Cerebrovascular Center and Clinical Research Institute, National Hospital Organization Kyushu Medical Center.

出版信息

Circ J. 2014;78(3):738-42. doi: 10.1253/circj.cj-13-1072. Epub 2013 Dec 27.

DOI:10.1253/circj.cj-13-1072

PMID:24389596

Abstract

BACKGROUND

The features of acute aortogenic embolic stroke on magnetic resonance diffusion-weighted imaging (DWI) have not been fully elucidated, so we compared patients with acute aortogenic embolic stroke and those with acute cardioembolic stroke.

METHODS AND RESULTS

This study included 40 consecutive patients with acute aortogenic embolic stroke, and 40 age- and sex-matched patients with acute cardioembolic stroke. The diagnosis of aortogenic embolic stroke was made when patients met 5 criteria: (1)acute neurologic event lasting >24h; (2) positive signals on DWI; (3) atherosclerotic lesions ≥3.5-mm thick at the aortic arch on transesophageal echocardiography; (4) neuroradiologic features suggesting embolic stroke, such as lesions involving the brain cortex or the re-opening phenomenon of previously occluded vessels on Magnetic Resonance Angiography (MRA); and (5) absence of other embolic sources, including heart disease and carotid stenosis. The number, site, and maximal diameter of the infarct lesions on DWI were compared between the aortogenic and cardiogenic groups. The aortogenic patients more frequently had ≥3 lesions (25.0% vs. 2.5%, P<0.01), lesions with a maximal diameter <30mm (77.5% vs. 20.0%, P< 0.001), and vertebrobasilar system lesions (55.0% vs. 10.0%, P< 0.001) than the cardiogenic patients.

CONCLUSIONS

Acute aortogenic embolic stroke is characterized by multiple (≥3) and small lesions, and involvement of the vertebrobasilar system.

摘要

背景

急性主动脉源性栓塞性卒中在磁共振扩散加权成像（DWI）上的特征尚未完全阐明，因此我们比较了急性主动脉源性栓塞性卒中和急性心源性栓塞性卒中的患者。

方法与结果

本研究纳入了40例连续的急性主动脉源性栓塞性卒中患者，以及40例年龄和性别匹配的急性心源性栓塞性卒中患者。当患者符合以下5条标准时诊断为主动脉源性栓塞性卒中：（1）急性神经事件持续时间>24小时；（2）DWI上信号阳性；（3）经食管超声心动图显示主动脉弓处动脉粥样硬化病变≥3.5毫米厚；（4）神经放射学特征提示栓塞性卒中，如磁共振血管造影（MRA）上累及脑皮质的病变或先前闭塞血管的再通现象；（5）不存在其他栓塞源，包括心脏病和颈动脉狭窄。比较了主动脉源性组和心源性组DWI上梗死灶的数量、部位和最大直径。与心源性患者相比，主动脉源性患者更常出现≥3个病灶（25.0%对2.5%，P<0.01）、最大直径<30mm的病灶（77.5%对20.0%，P<0.001）以及椎基底系统病灶（55.0%对10.0%，P<0.001）。