急性缺血性卒中的DWI病灶分型与病因分型的关系

摘要

目的：探讨急性缺血性卒中（CIS）磁共振弥散加权成像（DWI）的病灶分型与病因分型的关系。方法：回顾性调查急性CIS患者461例，分别进行DWI影像学病灶分型与韩国改良TOAST（M-TOAST）分型，并分析两者之间的相关性。结果：急性CIS的DWI影像学病灶分型与M-TOAST分型相关（=-1.87，=0.000）。其中21例大穿通支梗死（x2=6.189，=0.013）、6例小穿通支梗死（x2=102.869，=0.000）、33例幕下单发梗死（x2=4.420，=0.036）、21例前循环散发梗死（x2=11.376，P=0.001）、13例后循环散发梗死（x2=7.937，=0.005）、29例单侧前循环多发梗死（x2=10.725，P=0.001）、21例后循环多发梗死（x2=67.984，=0.005）与大动脉粥样硬化性血栓形成有关，11例皮质-皮质下单发梗死（x2=27.285，=0.000）、6例双侧前循环多发梗死（x2=5.292，=0.021）、9例后循环多发梗死（x2=4.478，=0.034）、5例双侧前-后循环多发梗死（x2=7.979，=0.005）与心源性栓塞有关，120例小的穿通支梗死（x2=268.027，=0.000）与小血管病变有关。结论：急性CIS发病初期可能可以通过病灶的DWI病灶分型推测病因。%ObjectiveTo study the relationship between types of lesions on magnetic resonance diffusion weighted imaging (DWI) and etiology of acute cerebral ischemic stroke. Methods:A retrospective investigation was performed out in 461 patients with acute cerebral ischemic stroke. The participants were grouped according to DWI and modified TOAST (M-TOAST) classification. The relationship between the DWI and M-TOAST classificatin was analyzed. Results:The imaging appearance on DWI was related with M-TOAST classification (rs=-1.87, =0.000). Among all the patients, 21 patients with large penetrating branch infarction ( x=6.189, =0. 013), 6 patients with small penetrating branch infarction ( x=102.869, =0.000), 33 patients with single infarction of inferior tentorium of cerebellum ( x=4.420, =0.036), 21 patients with scattered infarctions involving one artery territory of anterior circulation ( x=11.376, =0.001), 13 patients with scattered infarctions involving one artery territory of posterior circulation ( x=7.937, =0.005), 29 patients with unilateral multiple infarctions of anterior circulation (x=10.725, =0.001) and 21 patients with multiple infarctions of posterior circulation ( x=67.984, =0. 005) were closely associated with atherothrombosis. 11 patients with single cortical-subcortical infarction (x=27.285, =0.000), 6 patients with bilateral multiple infarctions of anterior circulation ( x=5.292, =0.021), 9 patients with multiple infarctions of posterior circulation ( x=4.478, =0.034), 5 patients with bilateral multiple infarctions of anterior and posterior circulation ( x=7.979, =0.005) were associated with cardioembolism. One hundred and twenty patients with small penetrating branch infarction ( x=268.027, =0.000) were associated with small artery disease. Conclusion:DWI is useful in predicting the etiology of acute cerebral ischemic strokes.