Jiang Shuai, Cui Jing-Yu, Yan Yu-Ying, Yang Tang, Tao Wen-Dan, Wu Bo
Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu 610041, Sichuan, China.
Ther Adv Neurol Disord. 2022 Jul 4;15:17562864221109746. doi: 10.1177/17562864221109746. eCollection 2022.
Whether altered cerebral perfusion is associated with the pathogenesis of single subcortical infarctions (SSIs) in the lenticulostriate artery (LSA) territory remains unclear.
We aimed to assess whether cerebral perfusion abnormalities are related to LSA impairments in the subacute phase of SSIs and then to examine their correlations with etiological subtypes of SSIs.
A total of 110 patients with acute SSIs in the LSA territory were prospectively recruited between July 2017 and October 2021, and they underwent magnetic resonance perfusion-weighted imaging (PWI) and whole-brain vessel-wall imaging (VWI) within 7 days of stroke onset. Based on VWI, patients were assigned to one of two SSI subtypes: branch atheromatous disease (BAD, = 78, 70.9%) or lacunar infarction related to cerebral small vessel disease (CSVD-related LI, = 32, 29.1%). Perfusion maps and LSA morphology were also quantitatively assessed.
Based on PWI, 22 patients (20%) had hypoperfusion and 88 (80%) showed normal perfusion. Compared with normal individuals, patients with hypoperfusion showed shorter average LSA length (23.48 ± 4.81 mm 25.47 ± 3.74 mm, = 0.037). Compared with patients with CSVD-related LI, patients with BAD had significantly lower relative cerebral blood flow [0.95 (IQR 0.81-1.12) 1.04 (IQR 0.92-1.22); = 0.036] and cerebral blood volume [0.95 (IQR 0.84-1.15) 1.14 (IQR 0.97-1.27); = 0.020] after adjusting for hypertension, number of LSA branches, and infarct volume.
Compromised cerebral perfusion is associated with impairments in the LSA and with BAD pathogenesis. Perfusion magnetic resonance imaging can provide important insights into acute SSI pathophysiology, and it may be useful for determining the clinical significance of perfusion abnormalities in BAD occurrence.
大脑灌注改变是否与豆纹动脉（LSA）区域单发皮质下梗死（SSIs）的发病机制相关尚不清楚。
我们旨在评估大脑灌注异常是否与SSIs亚急性期的LSA损伤有关，进而研究它们与SSIs病因亚型的相关性。
2017年7月至2021年10月前瞻性招募了110例LSA区域急性SSIs患者，他们在卒中发作7天内接受了磁共振灌注加权成像（PWI）和全脑血管壁成像（VWI）。根据VWI，患者被分为两种SSIs亚型之一：分支动脉粥样硬化疾病（BAD，n = 78，70.9%）或与脑小血管病（CSVD）相关的腔隙性梗死（CSVD相关LI，n = 32，29.1%）。还对灌注图和LSA形态进行了定量评估。
基于PWI，22例患者（20%）存在灌注不足，88例（80%）显示灌注正常。与正常个体相比，灌注不足的患者LSA平均长度较短（23.48±4.81mm对25.47±3.74mm，P = 0.037）。与CSVD相关LI患者相比，调整高血压、LSA分支数量和梗死体积后，BAD患者的相对脑血流量[0.95（四分位间距0.81 - 1.12）对1.04（四分位间距0.92 - 1.22）；P = 0.036]和脑血容量[0.95（四分位间距0.84 - 1.15）对1.14（四分位间距0.97 - 1.27）；P = 0.020]显著更低。
大脑灌注受损与LSA损伤及BAD发病机制相关。灌注磁共振成像可为急性SSIs病理生理学提供重要见解，可能有助于确定灌注异常在BAD发生中的临床意义。
