Consecutive Slides on Axial View Is More Effective Than Transversal Diameter to Differentiate Mechanisms of Single Subcortical Infarctions in the Lenticulostriate Artery Territory

Yuze Cao, Mengyu Zhang, Lixin Zhou, Ming Yao, Bin Peng, Yicheng Zhu, Jun Ni, Liying Cui, Yuze Cao, Mengyu Zhang, Lixin Zhou, Ming Yao, Bin Peng, Yicheng Zhu, Jun Ni, Liying Cui

Abstract

Objective: Lipohyalinosis or atherosclerosis might be responsible for single subcortical infarctions (SSIs); however, ways of differentiating between the two clinically remain uncertain. We aimed to investigate whether consecutive slides on axial view or transversal diameter is more effective to differentiate mechanisms by comparing their relationships with white matter hyperintensities (WMHs). Methods: All the participants from the Standard Medical Management in Secondary Prevention of Ischemic stroke in China (SMART) cohort who had SSIs in the lenticulostriate artery territory were included and categorized according to consecutive slides on axial view (≥4 consecutive slices or not) and transversal diameter (≥15 mm or not). The associations between the severity of WMHs and the different categories were analyzed. Results: Among the 3,821 patients of the SMART study, 281 had diffusion-weighted image-proven SSIs in the lenticulostriate artery territory. When classified by consecutive slides on axial view, SSIs on ≥4 slices were significantly associated with the severity of the WMHs, both in deep WMH (DWMH) (odds ratio [OR], 0.32; 95% confidence interval [CI], 0.11-0.97; p = 0.04) and periventricular hyperintensity (PVH) (OR, 0.37; 95% CI, 0.17-0.78; p = 0.01). No such association was found on the basis of the transversal diameter (p > 0.1). Conclusion: Consecutive slides on axial view (≥4 consecutive slices) might be more effective than transversal diameter to identify the atherosclerotic mechanisms of SSIs in the lenticulostriate artery territory. Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT00664846.

Keywords: SMART study; etiological categorization; lenticulostriate artery territory; single subcortical infarction; white matter hyperintensity.

Figures

Figure 1
Figure 1
(A) 57-year-old male, consecutive slices DWI imaging: infarct lesion ≥4 slices, involving the base of basal ganglia, but the maximum axial diameter is 21.7 mm. (B) 52-year-old male, consecutive slices DWI imaging: infarction lesion ≤3 slices, involving radiation corona, and the maximum diameter of axis is 21.2 mm.

References

    1. Fisher CM. Lacunes: small, deep cerebral infarcts. Neurology. (1965) 15:774–84. 10.1212/WNL.15.8.774
    1. Caplan LR. Intracranial branch atheromatous disease: a neglected, understudied, and underused concept. Neurology. (1989) 39:1246–50. 10.1212/WNL.39.9.1246
    1. Petrone L, Nannoni S, Del Bene A, Palumbo V, Inzitari D. Branch atheromatous disease: a clinically meaningful, yet unproven concept. Cerebrovasc Dis. (2016) 41:87–95. 10.1159/000442577
    1. Fisher CM, Caplan LR. Basilar artery branch occlusion: a cause of pontine infarction. Neurology. (1971) 21:900–5. 10.1212/WNL.21.9.900
    1. Fisher CM. Capsular infarcts: the underlying vascular lesions. Arch Neurol. (1979) 36:65–73. 10.1001/archneur.1979.00500380035003
    1. Kim JS, Yoon Y. Single subcortical infarction associated with parental arterial disease: important yet neglected sub-type of atherothrombotic stroke. Int J Stroke. (2013) 8:197–203. 10.1111/j.1747-4949.2012.00816.x
    1. Suto Y, Nakayasu H, Maeda M, Kusumi M, Kowa H, Awaki E, et al. . Long-term prognosis of patients with large subcortical infarctions. Eur Neurol. (2009) 62:304–10. 10.1159/000235943
    1. Peng B, Zhu Y, Cui L, Ni J, Xu W, Zhou L, et al. . Standard medical management in secondary prevention of ischemic stroke in China (SMART). Int J Stroke. (2011) 6:461–5. 10.1111/j.1747-4949.2011.00648.x
    1. Peng B, Ni J, Anderson CS, Zhu Y, Wang Y, Pu C, et al. . Implementation of a structured guideline-based program for the secondary prevention of ischemic stroke in China. Stroke. (2014) 45:515–9. 10.1161/STROKEAHA.113.001424
    1. Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, et al. . Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. (2013) 12:822–38. 10.1016/S1474-4422(13)70124-8
    1. Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol. (1987) 149:351–6. 10.2214/ajr.149.2.351
    1. Kwan MW, Mak W, Cheung RT, Ho SL. Ischemic stroke related to intracranial branch atheromatous disease and comparison with large and small artery diseases. J Neurol Sci. (2011) 303:80–4. 10.1016/j.jns.2011.01.008
    1. Yoon Y, Lee DH, Kang DW, Kwon SU, Suh DC, Bang OY, et al. . Stroke recurrence patterns are predicted by the subtypes and mechanisms of the past, non-cardiogenic stroke. Eur J Neurol. (2013) 20:928–34. 10.1111/ene.12101
    1. Chung JW, Kim BJ, Sohn CH, Yoon BW, Lee SH. Branch atheromatous plaque: a major cause of lacunar infarction (high-resolution MRI study). Cerebrovasc Dis Extra. (2012) 2:36–44. 10.1159/000341399
    1. Miyaji Y, Kawabata Y, Joki H, Seki S, Mori K, Kamide T, et al. . High-resolution magnetic resonance imaging findings of basilar artery plaque in a patient with branch atheromatous disease: a case report. J Med Case Rep. (2014) 8:395. 10.1186/1752-1947-8-395
    1. Men X, Wu A, Zhang B, Li H, Zhang L, Chen S, et al. . Leukoaraiosis and NIHSS score help to differentiate subtypes of intracranial branch atheromatous disease in Southern Han Chinese patients with stroke. Neurol Sci. (2013) 34:1727–33. 10.1007/s10072-013-1322-z
    1. Nakase T, Yoshioka S, Sasaki M, Suzuki A. Clinical evaluation of lacunar infarction and branch atheromatous disease. J Stroke Cerebrovasc Dis. (2013) 22:406–12. 10.1016/j.jstrokecerebrovasdis.2011.10.005
    1. Zhou L, Yao M, Peng B, Zhu Y, Ni J, Cui L. Atherosclerosis might be responsible for branch artery disease: evidence from white matter hyperintensity burden in acute isolated pontine infarction. Front Neurol. (2018) 9:840. 10.3389/fneur.2018.00840
    1. Deguchi I, Hayashi T, Kato Y, Nagoya H, Ohe Y, Fukuoka T, et al. . Treatment outcomes of tissue plasminogen activator infusion for branch atheromatous disease. J Stroke Cerebrovasc Dis. (2013) 22:e168–72. 10.1016/j.jstrokecerebrovasdis.2012.10.012
    1. Miyazawa H, Natori T, Kameda H, Sasaki M, Ohba H, Narumi S, et al. . Detecting lenticulostriate artery lesions in patients with acute ischemic stroke using high-resolution MRA at 7 T. Int J Stroke. (2018) 14:290–7. 10.1177/1747493018806163

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