Hong Hui, Zhang Ruiting, Yu Xinfeng, Jiaerken Yeerfan, Wang Shuyue, Luo Xiao, Lou Min, Huang Peiyu, Zhang Minming
Department of Radiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Front Aging Neurosci. 2020 Aug 26;12:264. doi: 10.3389/fnagi.2020.00264. eCollection 2020.
Recent small subcortical infarcts (RSSIs) can occur in different brain regions. Distinct etiologies might be involved for RSSIs in different locations and could further affect RSSI cavitation and functional outcomes. In this study, we aim to analyze the baseline clinical and imaging characteristics associated with the occurrence and cavitation of RSSIs in different locations. We retrospectively include patients who presented with RSSIs from a database for cerebral small vessel disease. Detailed information, including demographic, clinical, laboratory, and radiological data, were collected. We identify baseline RSSIs on diffusion-weighted images and divide them into brainstem, subcortical white matter, and basal ganglia region groups. Cavitation is evaluated on follow-up T2 fluid-attenuated inversion recovery (FLAIR) images. Statistical analysis is performed to determine factors associated with the occurrence and cavitation of RSSIs in different locations. We find that patients with brainstem RSSIs have a higher proportion of diabetes (64.1%) compared to patients with subcortical white matter (27.3%, < 0.001) and basal ganglia region RSSIs (35.2%, = 0.006) and have higher levels of HbA1c (7.20%) compared to patients with subcortical white matter (6.10%, = 0.001) and basal ganglia region RSSIs (6.20%, = 0.003). In addition, patients with brainstem RSSIs have higher NIHSS scores than patients with subcortical white matter RSSIs (2 vs 0, = 0.001). Patients with subcortical white matter RSSIs have higher a white matter hyperintensity (WMH) burden compared to patients with basal ganglia region RSSIs (21.64 cm vs 11.10 cm, = 0.004). Follow-up analysis demonstrates that basal ganglia region RSSIs are less likely to cavitate than subcortical white matter RSSIs (61.4% vs 83.6%, = 0.010), and contacting with WMH is associated with the cavitation of subcortical white matter RSSIs (OR: 101.760, = 0.003). Our study demonstrates that RSSIs in different locations are associated with different clinical and imaging characteristics. Furthermore, cavitation of RSSIs might be affected by local lesion features and the surrounding environment rather than general demographic and clinical factors.
近期皮质下小梗死灶（RSSIs）可发生于不同脑区。不同部位的RSSIs可能涉及不同病因，且可能进一步影响RSSIs的空洞形成及功能转归。在本研究中，我们旨在分析与不同部位RSSIs的发生及空洞形成相关的基线临床和影像学特征。我们回顾性纳入了来自脑小血管病数据库中出现RSSIs的患者。收集了详细信息，包括人口统计学、临床、实验室及放射学数据。我们在扩散加权图像上识别基线RSSIs，并将其分为脑干、皮质下白质和基底节区组。在随访的T2液体衰减反转恢复（FLAIR）图像上评估空洞形成情况。进行统计分析以确定与不同部位RSSIs的发生及空洞形成相关的因素。我们发现，与皮质下白质RSSIs患者（27.3%，P<0.001）及基底节区RSSIs患者（35.2%，P = 0.006）相比，脑干RSSIs患者糖尿病比例更高（64.1%）；与皮质下白质RSSIs患者（6.10%，P = 0.001）及基底节区RSSIs患者（6.20%，P = 0.003）相比，脑干RSSIs患者糖化血红蛋白（HbA1c）水平更高（7.20%）。此外，脑干RSSIs患者的美国国立卫生研究院卒中量表（NIHSS）评分高于皮质下白质RSSIs患者（2分对0分，P = 0.001）。与基底节区RSSIs患者相比，皮质下白质RSSIs患者的白质高信号（WMH）负荷更高（21.64 cm对11.10 cm，P = 0.004）。随访分析表明，基底节区RSSIs比皮质下白质RSSIs空洞形成的可能性更小（61.4%对83.6%，P = 0.010），且与WMH接触与皮质下白质RSSIs的空洞形成相关（比值比：101.760，P = 0.003）。我们的研究表明，不同部位的RSSIs与不同的临床和影像学特征相关。此外，RSSIs的空洞形成可能受局部病变特征及周围环境影响，而非一般人口统计学和临床因素。
