Gao Yuan, Song Bo, Zhao Lu, Fang Hui, Ji Yan, Yong Quan, Wu Zhengrong, Xu Yuming
Department of Neurology, The first Affiliated Hospital of Zhengzhou University, No.1 Jian-she East Road, Zhengzhou, 450052, Henan. China.
Department of Neurology, the first Affiliated Hospital of Zhengzhou University, No.1 Jian-she East Road, Zhengzhou, 450052, Henan. China.
Curr Neurovasc Res. 2017;14(3):215-221. doi: 10.2174/1567202614666170621104824.
Early neurological deterioration (END) was common in single small subcortical infarction (SSSI). Distal type of SSSI (dSSSI) was reported to have a lower risk of END than proximal type of SSSI (pSSSI) in lenticulostriate artery(LSA) territory. However, dSSSIs with different lesion thickness might have different risks of END.
In this prospective cohort study, we aimed to investigate whether dSSSIs visible on ≥3 serial axial diffusion weighted imaging (DWI) slices were also imaging markers for END.
Patients of SSSIs in the LSA territory admitted within 72 hours from the onset were selected in a prospective stroke database. Clinical characteristics including the occurrence of END after admission were recorded. The lowest slice (LS), total number of slices (TNS) involved and the maximum axial diameter were evaluated for lesion location and size on axial plane of DWI images. Lesion patterns were categorized according to LS and TNS. Multivariate logistic analysis was performed to determine the imaging pattern that associated with END.
A total of 201 out of 1,158 patients were analyzed. END occurred in 32(15.9%) patients after admission. SSSI was categorized to pSSSI (LS≤2), distal and large SSSI (dl-SSSI, LS>2, TNS≥3), distal and small SSSI (ds-SSSI, LS>2, TNS<3) respectively. Multivariate logistic analysis showed that ds-SSSI patients had a significantly lower rate of END(OR 0.20, 95% CI 0.06-0.71, P=0.013) comparing to dl-SSSI patients; pSSSI patients, however, had a similar rate of END (OR 1.27, 95% CI 0.50-3.21, P=0.611) to dl-SSSI patients.
Except for pSSSI, dl-SSSI was also an imaging marker for END in the territory of LSA.
早期神经功能恶化（END）在单个小的皮质下梗死（SSSI）中很常见。据报道，在豆纹动脉（LSA）区域，远端型SSSI（dSSSI）发生END的风险低于近端型SSSI（pSSSI）。然而，不同病灶厚度的dSSSIs发生END的风险可能不同。
在这项前瞻性队列研究中，我们旨在调查在≥3个连续轴位扩散加权成像（DWI）切片上可见的dSSSIs是否也是END的影像学标志物。
从一个前瞻性卒中数据库中选取发病72小时内入院的LSA区域SSSIs患者。记录临床特征，包括入院后END的发生情况。在DWI图像的轴位平面上评估病灶位置和大小的最低切片（LS）、累及的切片总数（TNS）和最大轴径。根据LS和TNS对病灶模式进行分类。进行多因素逻辑分析以确定与END相关的影像学模式。
共分析了1158例患者中的201例。32例（15.9%）患者入院后发生END。SSSI分别分为pSSSI（LS≤2）、远端大SSSI（dl-SSSI，LS>2，TNS≥3）、远端小SSSI（ds-SSSI，LS>2，TNS<3）。多因素逻辑分析显示，与dl-SSSI患者相比，ds-SSSI患者发生END的比率显著更低（OR 0.20，95%CI 0.06-0.71，P=0.013）；然而，pSSSI患者发生END的比率与dl-SSSI患者相似（OR 1.27，95%CI 0.50-3.21，P=0.6）。
除pSSSI外，dl-SSSI也是LSA区域END的影像学标志物。
