急性缺血性脑卒中患者DWI表现与TOAST病因分型的关系

目的探讨急性缺血性脑卒中患者DWI表现与TOAST病因分型的关系。材料与方法回顾性分析2012年至2015年内住院治疗急性缺血性脑卒中患者共939例,根据患者的DWI及MRA影像学表现,临床资料及相关辅助检查判断TOAST分型,利用统计学方法分析病灶表现与病因分型的相关性。结果 939例患者中单发梗死组和多发梗死组患者例数分别为437例和502例,与单发梗死组相比,多发梗死组患者平均年龄稍大且患有高同型半胱氨酸血症及房颤的比例更多。患者TOAST亚型所占比例分别为LAA 49.6%、SVO 38.9%、CE 6.3%、SUE 5.2%,未有患者判定为SOE型。缺血性脑卒中患者的DWI表现形态与TOAST分型关系差异具有显著性意义(χ~2=398.470,P=0.000):其中75例大穿通支梗死(χ~2=47.199,P=0.000)、175例单侧前循环梗死(χ~2=39.772,P=0.000)和91例前-后循环梗死(χ~2=23.967,P=0.000)主要与LAA型有关;239例小穿通支梗死主要与SVO型有关(χ~2=332.102,P=0.000)。结论急性缺血性脑卒中患者的DWI表现与TOAST病因分型有关,可帮助临床判断病因。

Relationship between the diffusion-weighted imaging patterns of ischemic stroke in acute stage and the TOAST etiological type

Objective:To evaluate the relationship between the imaging appearance on DWI of ischemic stroke in acute stage and the TOAST etiological type.Materials and Methods:We retrospectively analysed 939 patients admitted to neurology department of our hospital who were diagnosed as acute ischemic stroke or TIA in 2012—2015, according to the patients' DWI and MRA imaging ifndings, clinical data and related auxiliary examinations to evaluate TOAST etiological type, using statistical methods to analyse the correlation of the imaging appearance on DWI and TOAST etiological type.Results:There were 437 cases in the single infraction group and 502 cases in the multiple infraction group. Comparing to the single infraction group, the patients in multiple infraction group were older and had higher proportion of atrial ifbrillation and hyperhomocysteinemia. Proportion of patients' TOAST subtypes were: LAA 49.6%, SVO 38.9%, CE 6.3%, SUE 5.2%, and there were no patients evaluated for SOE. The imaging appearance on DWI in acute stage of ischemic stroke had relationship with the TOAST etiological type (χ2=398.470,P=0.000), 75 cases of large penetrating branch infraction (χ2=47.199,P=0.000), 175 cases of anterior circulation unilateral infraction (χ2=39.772,P=0.000) and 91 cases of anterior- posterior circulation infarction (χ2=23.967, P=0.000) were mainly related to LAA type. Two hundred and thirty-nine cases of small penetrating branch infarction were mainly related to SVO type (χ2=332.102,P=0.000). Conclusions:The imaging appearance on DWI in acute stage of ischemic stroke has relationship with the TOAST etiological type. Early DWI and MRA imaging ifndings can help the clinic to predict the etiology of ischemic stroke in acute stage.