急性脑梗死磁共振扩散加权成像与TOAST分型、传统危险因素的关系探讨

目的探讨急性脑梗死磁共振扩散加权成像(diffusion weighted imaging,DWI)与急性卒中治疗Org 10172试验(trial of org 10172 in acute stroke treatment,TOAST)分型、传统危险因素的关系。材料与方法选择在本院神经内科住院的急性脑梗死患者942例,行头颅DWI检查后,记录其DWI影像学分型;年龄、高血压等临床资料;糖尿病、血脂等实验室常规检查,并根据结果行TOAST分型,对DWI表现与TOAST、传统危险因素进行统计学分析。结果 942例急性脑梗死患者中,大动脉粥样硬化型(large artery atherosclerosis,LAA)占比最高(49.04%),其次为小动脉闭塞型(small artery occlusion,SAO)(39.49%)、心源性栓塞型(cardioembolism,CE)(6.16%)、不明原因型(undetermined etiology,UND)(5.20%)、其他原因型(other determined etiology,OC)(0.11%)。DWI影像学特点与TOAST分型存在显著的相关性(χ~2=397.785,P=0.000)。皮质-皮质下梗死、单侧前循环梗死、大的穿通支梗死、前-后循环梗死多与LAA型有关,差异有明显统计学意义(P0.05);小的穿通支梗死多与SAO型有关;差异有统计学意义(P0.05)。皮质梗死、双侧前循环梗死及后循环梗死与TOAST分型无明显相关性(P0.05)。在942例急性脑梗死DWI分型中,年龄、NIHSS评分、冠心病、房颤的组间差异显著(P0.05),434例单发病灶的平均直径为(20.75±19.81)mm,组间比较差异有统计学意义(P=0.000),508例多发病灶的平均最大直径为(33.39±26.92)mm,组间比较差异有统计学意义(P=0.000),平均最小直径为(5.20±3.27)mm,组间比较差异无统计学意义(P=0.513)。结论 DWI影像学特点与急性脑梗死患者的TOAST分型有关,年龄、NIHSS评分、冠心病、房颤等传统危险因素对DWI影像学特点具有一定的影响,因此,急性脑梗死患者早期行DWI影像学检查,结合临床传统危险因素,可以指导临床选择较优治疗方案,降低致残率和致死率。

Relation between magnetic resonance diffusion-weighted imaging and TOAST classification,traditional risk factors of acute cerebral infarction

Objective:To study the relationship between magnetic resonance diffusion-weighted imaging(DWI)and trial of org 10172 in acute stroke treatment(TOAST)classification,traditional risk factors of acute cerebral infarction.Materials and Methods: Nine hundred and forty-two patients admitted to our hospital neurology department with acute cerebral infarction were enrolled.After DWI,the magnetic resonance DWI classification,clinical data such as age,hypertension and laboratory findings such as diabetes,blood fat were recorded.The TOAST of patients was classified according to them.The relationship between DWI and TOAST classification,traditional risk factors were analyzed.Results: In 942 cases of acute cerebral infarction patients,large artery atherosclerosis(LAA)type(49.04％)was the highest proportion,followed by small artery occlusion(SAO)(39.49％)and cardioembolism(CE)(6.16％),undetermined etiology(UND)(5.20％),other determined etiology(OC)(0.11％).The DWI was related with the TOAST classification in acute cerebral infarction patients(χ2=397.785,P=0.000).The cortical and subcortical infarction,the big penetrating branch infarction,unilateral anterior circulation infarction,anterior and posterior circulation infarction were mainly related with LAA type,and there were significant difference(P＜0.05).The small penetrating branch infarction was mainly related with SAO type,and the difference was statistically significant(P＜0.05).There were no significant between cortical infarction,bilateral anterior circulation infarction,posterior circulation infarction and TOAST(P＞0.05).Age,NIHSS score,coronary heart disease,atrial fibrillation had significant difference between groups in DWI of 942 cases acute cerebral infarction(P＜0.05).The average diameter of 434 cases with single lesions was 20.75±19.81,the significant difference was compared between groups(P=0.000); the average diameter of 508 patients with multiple lesions was(33.39±26.92)mm,the significant difference was compared between groups(P=0.000),the average minimum diameter is(5.20±3.27)mm,and there was no statistical difference between groups(P=0.513).Conclusions: DWI characteristics of patients with acute cerebral infarction has relationship with TOAST classification.The traditional risk factors such as age,NIHSS score,coronary heart disease,atrial fibrillation have a certain influence on DWI characteristics.Therefore,for patients with acute cerebral infarction,early DWI examination combined with the traditional clinical risk factors can guide the clinical diagnosis and select optimal treatment,so as to reduce the morbidity and mortality.