Gattringer Thomas, Eppinger Sebastian, Pinter Daniela, Pirpamer Lukas, Berghold Andrea, Wünsch Gerit, Ropele Stefan, Wardlaw Joanna M, Enzinger Christian, Fazekas Franz
Department of Neurology, Medical University of Graz, Graz, Austria.
Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
Int J Stroke. 2015 Oct;10(7):1037-43. doi: 10.1111/ijs.12499. Epub 2015 Apr 12.
New imaging criteria for recent small subcortical infarcts have recently been proposed, replacing the earlier term 'lacunar infarction', but their applicability and impact on lesion selection is yet unknown.
To collect information on the morphologic characteristics and variability of recent small subcortical infarcts on magnetic resonance imaging in regard to lesion location and demographic variables.
We identified all patients with acute stroke and cerebral magnetic resonance imaging from 2008 to 2013 in our hospital database and selected those with a single recent small subcortical infarct defined by an estimated maximal axial diameter of 20 mm. Recent small subcortical infarcts were segmented on diffusion-weighted imaging and fluid-attenuated inversion recovery sequence to calculate the largest axial and longitudinal diameter and lesion volume. We assessed morphometric differences of recent small subcortical infarcts regarding location and demographic variables and the impact of different recent small subcortical infarct definitions on lesion selection.
Three hundred forty-four patients (median age 72; range 25-92 years, 65% male) were selected. Most recent small subcortical infarcts were located in the basal ganglia (n = 111), followed by pons (n = 92), thalamus (n = 77), and centrum semiovale (n = 64). Quantitative measurements confirmed visual assessment of the axial diameter in 95%. All morphometric variables were strongly intercorrelated and comparable on diffusion-weighted imaging and fluid-attenuated inversion recovery sequence. Recent small subcortical infarcts in the basal ganglia were significantly larger both in the axial and longitudinal direction compared with other regions. Dichotomization of recent small subcortical infarcts according to axial (≤ / >15 mm) or longitudinal (≤ / >20 mm) sizes resulted in different regional frequencies and distributions. Age, gender, and time from stroke onset to magnetic resonance imaging did not influence lesion metrics or the distribution of recent small subcortical infarcts.
Our study confirms the recent neuroimaging criteria for recent small subcortical infarcts as a practical concept. Definitions of the maximal axial and longitudinal diameter have a significant impact on the frequency and distribution of selected infarcts, which has to be considered for future studies.
最近提出了针对近期小皮质下梗死的新影像学标准，取代了早期的术语“腔隙性梗死”，但其适用性以及对病变选择的影响尚不清楚。
收集关于近期小皮质下梗死在磁共振成像上的形态学特征及变异性的信息，涉及病变位置和人口统计学变量。
我们在医院数据库中识别出2008年至2013年所有患有急性卒中且进行了脑磁共振成像的患者，并选择那些近期有单个小皮质下梗死的患者，其梗死灶估计最大轴向直径为20毫米。在扩散加权成像和液体衰减反转恢复序列上对近期小皮质下梗死灶进行分割，以计算最大轴向和纵向直径以及病变体积。我们评估了近期小皮质下梗死在位置和人口统计学变量方面的形态学差异，以及不同的近期小皮质下梗死定义对病变选择的影响。
共选择了344例患者（中位年龄72岁；年龄范围25 - 92岁，65%为男性）。大多数近期小皮质下梗死位于基底节（n = 111），其次是脑桥（n = 92）、丘脑（n = 77）和半卵圆中心（n = 64）。定量测量在95%的情况下证实了对轴向直径的视觉评估。所有形态学变量在扩散加权成像和液体衰减反转恢复序列上都高度相关且具有可比性。与其他区域相比，基底节的近期小皮质下梗死在轴向和纵向方向上都明显更大。根据轴向（≤ / >15毫米）或纵向（≤ / >20毫米）大小对近期小皮质下梗死进行二分法划分，会导致不同的区域频率和分布。年龄、性别以及从卒中发作到磁共振成像的时间并未影响病变指标或近期小皮质下梗死的分布。
我们的研究证实了近期针对近期小皮质下梗死的神经影像学标准是一个实用的概念。最大轴向和纵向直径的定义对所选梗死灶的频率和分布有显著影响，这在未来的研究中必须予以考虑。
