Payabvash S, Taleb S, Benson J C, McKinney A M
From the Department of Radiology, University of Minnesota, Minneapolis, Minnesota.
AJNR Am J Neuroradiol. 2017 Jan;38(1):58-63. doi: 10.3174/ajnr.A4970. Epub 2016 Oct 6.
Acute stroke presentation and outcome depend on both ischemic infarct volume and location. We aimed to determine the association between acute ischemic infarct topology and lesion volume and stroke severity at presentation and discharge.
Patients with acute ischemic stroke who underwent MR imaging within 24 hours of symptom onset or last seen well were included. Infarcts were segmented and coregistered on the Montreal Neurological Institute-152 brain map. Voxel-based analyses were performed to determine the distribution of infarct lesions associated with larger volumes, higher NIHSS scores at admission and discharge, and greater NIHSS/volume ratios.
A total of 238 patients were included. Ischemic infarcts involving the bilateral lentiform nuclei, insular ribbons, middle corona radiata, and right precentral gyrus were associated with larger infarct volumes (average, 76.7 ± 125.6 mL versus 16.4 ± 24.0 mL, P < .001) and higher admission NIHSS scores. Meanwhile, brain stem and thalami infarctions were associated with higher admission NIHSS/volume ratios. The discharge NIHSS scores were available in 218 patients, in whom voxel-based analysis demonstrated that ischemic infarcts of the bilateral posterior insular ribbons, middle corona radiata, and right precentral gyrus were associated with more severe symptoms at discharge, whereas ischemic lesions of the brain stem, bilateral thalami, and, to a lesser extent, the middle corona radiata were associated with higher ratios of discharge NIHSS score/infarct volume.
Acute ischemic infarcts of the insulae, lentiform nuclei, and middle corona radiata tend to have larger volumes, more severe presentations, and worse outcomes, whereas brain stem and thalamic infarcts have greater symptom severity relative to smaller lesion volumes.
急性卒中的表现及预后取决于缺血性梗死灶的体积和位置。我们旨在确定急性缺血性梗死灶的拓扑结构与病灶体积以及发病时和出院时的卒中严重程度之间的关联。
纳入症状发作后24小时内或最后一次情况良好时接受磁共振成像检查的急性缺血性卒中患者。对梗死灶进行分割，并在蒙特利尔神经学研究所-152脑图谱上进行配准。进行基于体素的分析，以确定与较大体积、入院和出院时较高美国国立卫生研究院卒中量表（NIHSS）评分以及较高NIHSS/体积比相关的梗死灶分布。
共纳入238例患者。累及双侧豆状核、岛叶皮质、放射冠中部和右侧中央前回的缺血性梗死灶与较大的梗死灶体积（平均76.7±125.6 mL对16.4±24.0 mL，P<.001）和较高的入院NIHSS评分相关。同时，脑干和丘脑梗死与较高的入院NIHSS/体积比相关。218例患者有出院时的NIHSS评分，基于体素的分析表明，双侧岛叶后部皮质、放射冠中部和右侧中央前回的缺血性梗死灶与出院时更严重的症状相关，而脑干、双侧丘脑以及程度较轻的放射冠中部的缺血性病变与出院时NIHSS评分/梗死灶体积的较高比值相关。
岛叶、豆状核和放射冠中部的急性缺血性梗死灶往往体积较大、表现更严重且预后更差，而脑干和丘脑梗死相对于较小的病灶体积具有更严重的症状。
