Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States.
Stroke Vasc Neurol. 2019 Sep 3;4(4):198-205. doi: 10.1136/svn-2019-000268. eCollection 2019 Dec.
Functional outcomes after ischaemic stroke are worse in women, despite adjusting for differences in comorbidities and treatment approaches. White matter microvascular integrity represents one risk factor for poor long-term functional outcomes after ischaemic stroke. The aim of the study is to characterise sex-specific differences in microvascular integrity in individuals with acute ischaemic stroke.
A retrospective analysis of subjects with acute ischaemic stroke and brain MRI with diffusion-weighted (DWI) and dynamic-susceptibility contrast-enhanced (DSC) perfusion-weighted imaging obtained within 9 hours of last known well was performed. In the hemisphere contralateral to the acute infarct, normal-appearing white matter (NAWM) microvascular integrity was measured using the coefficient and apparent diffusion coefficient (ADC) values. Regression analyses for predictors of coefficient, DWI volume and good outcome (90-day modified Rankin scale (mRS) score <2) were performed.
105 men and 79 women met inclusion criteria for analysis. Despite no difference in age, women had increased NAWM coefficient (1027.4 vs 692.7×10/s; p=0.006). In women, atrial fibrillation (β=583.6; p=0.04) and increasing NAWM ADC (β=4.4; p=0.02) were associated with increased NAWM coefficient. In multivariable regression analysis, the coefficient was an independent predictor of DWI volume in women (β=0.007; p=0.01) but not men.
In women with acute ischaemic stroke, increased NAWM coefficient is associated with increased infarct volume and chronic white matter structural integrity. Prospective studies investigating sex-specific differences in white matter microvascular integrity are needed.
尽管调整了合并症和治疗方法的差异，女性缺血性卒中后的功能结局仍较差。脑白质微血管完整性是缺血性卒中后长期功能结局不良的一个危险因素。本研究旨在描述急性缺血性卒中患者的白质微血管完整性的性别特异性差异。
对发病 9 小时内接受弥散加权（DWI）和动态磁敏感对比增强（DSC）灌注加权成像检查的急性缺血性卒中患者的脑 MRI 进行回顾性分析。在急性梗死对侧的半球中，使用 系数和表观弥散系数（ADC）值测量正常表现的白质（NAWM）微血管完整性。对 系数、DWI 体积和良好结局（90 天改良 Rankin 量表（mRS）评分<2）的预测因子进行回归分析。
105 名男性和 79 名女性符合分析纳入标准。尽管年龄无差异，但女性的 NAWM 系数较高（1027.4 比 692.7×10/s；p=0.006）。在女性中，心房颤动（β=583.6；p=0.04）和 NAWM ADC 增加（β=4.4；p=0.02）与 NAWM 系数增加相关。在多变量回归分析中，系数是女性 DWI 体积的独立预测因子（β=0.007；p=0.01），但不是男性。
在急性缺血性卒中的女性中，增加的 NAWM 系数与增加的梗死体积和慢性白质结构完整性有关。需要进行前瞻性研究，以调查白质微血管完整性的性别特异性差异。
