Incidental DWI Lesions in Patients with Recent Small Subcortical Infarctions

ARSAVA E. M., YILMAZ E., TOPÇUOĞLU M. A.

JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, cilt.31, sa.4, 2022 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 31 Sayı: 4
  • Basım Tarihi: 2022
  • Doi Numarası: 10.1016/j.jstrokecerebrovasdis.2022.106304
  • Dergi Adı: JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE
  • Anahtar Kelimeler: Cerebral infarction, Stroke, Lacunar, Cerebral small vessel diseases, Neuroimaging, Diffusion magnetic resonance imaging, DIFFUSION-WEIGHTED MRI, SMALL-VESSEL DISEASE, MULTIPLE LACUNAR INFARCTS, SILENT BRAIN INFARCTS, RISK-FACTORS, ISCHEMIC-STROKE, EMBOLIC STROKE, CLASSIFICATION, ABNORMALITIES, DEMENTIA
  • Hacettepe Üniversitesi Adresli: Evet

Özet

Objectives: Incidental acute ischemic lesions distinct from the primary neurological insult are identified on diffusion-weighted imaging (DWI) in a number of conditions where cerebral microvascular pathology plays a central role. Another major manifestation of cerebral small vessel disease (CSVD) is ischemic stroke named as recent small subcortical infarction (RSSI). In this study, we sought to identify the prevalence and predictors of incidental DWI lesions in patients with RSSI. Materials and Methods: We retrospectively analyzed a consecutive series of acute ischemic stroke patients with DWI evidence of acute lesions solely localized to perforator artery territories. Images were evaluated for the presence of additional acute or subacute subcortical DWI lesions, apart from the symptomatic lesion. Clinical features including vascular risk factor burden, together with imaging markers of chronic CSVD, were compared among patients with and without incidental acute or subacute lesions. Results: Among 396 patients with no alternate stroke etiology additional incidental subcortical DWI bright lesions were identified in 74 (19%) cases. These lesions were primarily localized in the corona radiata, or centrum semiovale. Patients with incidental DWI lesions were more likely to have a history of hypertension, a higher white matter hyperintensities burden in the periventricular and subcortical region, higher perivascular spaces burden in the basal ganglia, multiple cerebral microbleeds, and multiple chronic lacunes. Presence of multiple chronic lacunes (OR 5.98, 95% CI 3.18-11.24) and >= 2 vascular risk factors (OR 2.03, 95% CI 1.05-3.91) stood out as features significantly associated with incidental DWI lesions in multivariate analysis. Conclusions: Our study shows that acute or subacute ischemic lesions can be incidentally detected in approximately one-fifth of patients with RSSI. This observation suggests that the course of CSVD might be more active, temporally and spatially, in a distinct subgroup of RSSI patients, specifically those with a higher chronic lacune and vascular risk factor burden.