Departments of Neurology (J.V., M.B., D.J.S., S.J., M.R.H., U.P., M.G., M.A., U.F., T.R.M.), Inselspital, Bern University Hospital, and University of Bern, Switzerland.
Diagnostic and Interventional Neuroradiology (J.K., N.F.B., L.G., J.G., T.D.), Inselspital, Bern University Hospital, and University of Bern, Switzerland.
Stroke. 2022 Feb;53(2):558-568. doi: 10.1161/STROKEAHA.121.034347. Epub 2021 Sep 16.
The aim of this study was to assess the rate of chronic covert brain infarctions (CBIs) in patients with acute ischemic stroke (AIS) and to describe their phenotypes and diagnostic value.
This is a single-center cohort study including 1546 consecutive patients with first-ever AIS on magnetic resonance imaging imaging from January 2015 to December 2017. The main study outcomes were CBI phenotypes, their relative frequencies, location, and association with vascular risk factors.
Any CBI was present in 574/1546 (37% [95% CI, 35%-40%]) of patients with a total of 950 CBI lesions. The most frequent locations of CBI were cerebellar in 295/950 (31%), subcortical supratentorial in 292/950 (31%), and cortical in 213/950 (24%). CBI phenotypes included lacunes (49%), combined gray and white matter lesions (30%), gray matter lesions (13%), and large subcortical infarcts (7%). Vascular risk profile and white matter hyperintensities severity (19% if no white matter hyperintensity, 63% in severe white matter hyperintensity, <0.001) were associated with presence of any CBI. Atrial fibrillation was associated with cortical lesions (adjusted odds ratio, 2.032 [95% CI, 1.041-3.967]). Median National Institutes of Health Stroke Scale scores on admission were higher in patients with an embolic CBI phenotype (median National Institutes of Health Stroke Scale, 5 [2-10], =0.025).
CBIs were present in more than a third of patients with first AIS. Their location and phenotypes as determined by MRI were different from previous studies using computed tomography imaging. Among patients suffering from AIS, those with additional CBI represent a vascular high-risk subgroup and the association of different phenotypes of CBIs with differing risk factor profiles potentially points toward discriminative AIS etiologies.
本研究旨在评估急性缺血性脑卒中（AIS）患者慢性隐匿性脑梗死（CBIs）的发生率，并描述其表型及诊断价值。
这是一项单中心队列研究，纳入了 2015 年 1 月至 2017 年 12 月期间 1546 例经磁共振成像（MRI）确诊的首次 AIS 患者。主要研究终点为 CBI 表型、相对频率、位置及其与血管危险因素的相关性。
574/1546（37% [95%CI，35%-40%]）例患者存在任何 CBI，共检出 950 处 CBI 病灶。CBI 最常见的部位为小脑 295/950（31%）、皮质下幕上 292/950（31%）和皮质 213/950（24%）。CBI 表型包括腔隙性脑梗死 49%、灰白质混合病变 30%、单纯皮质病变 13%和大皮质下梗死 7%。血管危险因素谱和脑白质高信号严重程度（无脑白质高信号者为 19%，严重脑白质高信号者为 63%，<0.001）与任何 CBI 的存在相关。心房颤动与皮质病变相关（校正比值比，2.032 [95%CI，1.041-3.967]）。栓塞性 CBI 表型患者入院时美国国立卫生研究院卒中量表（NIHSS）评分中位数较高（NIHSS 中位数，5[2-10]，=0.025）。
首次 AIS 患者中超过三分之一存在 CBI。其 MRI 确定的部位和表型与以往采用 CT 成像的研究不同。在发生 AIS 的患者中，存在其他 CBI 的患者代表了一个血管高风险亚组，不同 CBI 表型与不同危险因素谱之间的关联可能提示 AIS 病因存在差异。
