Stroke：卒中早期DWI病灶分布类型与再发病灶相关

卒中不同类型的弥散加权（DWI）病灶

急性缺血性卒中患者MRI上常见新发的弥散加权(DWI)病灶，这些病灶与卒中初始非单病灶型类型相关。先前的研究并没有详细分析这种相关性。来自德国的Tim Bastian Braemswig等学者们研究区分了单根血管供血区的多病灶型病变（分散病灶型）与超过2条血管支配区的多病灶病变（多区域病灶型），研究结果在线发表在2013年6月13日的stroke杂志上，结果显示：卒中早期DWI病灶分布状况与再发病灶相关。

纳入的所有急性缺血性卒中患者进行3T的MRI检查，检查时间为入院时、入院第二天及起病后4到7天。起先，评价者在不知临床表现的情况下描述DWI病灶；随后检查发现的高信号病灶与先前病灶对比分析。初始的病灶类型分为单病灶型，分散病灶型和多区域病灶型。

在纳入的340例患者中，43%为单病灶型，40%为分散病灶型，其余17%为多区域病灶型。多元分析显示，不同病灶类型与新发DWI病灶独立相关（多区域病灶型优势比为3.64,95%可信区间为1.75到7.58，分散病灶型优势比为1.96,95%可信区间为1.09至3.56）。多区域病灶型患者有更高的糖尿病发病率，此类型患者新发病灶与分散病灶型患者相比病灶多因为低灌注而位于远端。

早期图像的病灶类型是新发DWI病灶的独立危险因素。多区域病灶型患者新发DWI病灶的危险更高。

Early New Diffusion-Weighted Imaging Lesions Appear More Often in Stroke Patients With a Multiple Territory Lesion Pattern.
BACKGROUND AND PURPOSE
New diffusion-weighted imaging (DWI) lesions are common in patients with acute ischemic stroke. They are associated with an initial nonsingle lesion pattern. Previous studies have not analyzed this association in detail. We differentiated nonsingle lesions in 1 vascular supply territory only (scattered lesion pattern) from nonsingle lesions in ≥2 vascular supply territory (multiple territory lesion -pattern).
METHODS
Patients with an acute ischemic stroke underwent 3 MRI (3T) examinations: on admission, on the following day, and 4 to 7 days after symptom onset. First, DWI lesions were delineated manually by raters blinded to clinical details. Second, DWI images were coregistered and analyzed visually for new hyperintensities. The initial lesion pattern was categorized as single, scattered, or multiple territory.
RESULTS
Of 340 patients enrolled, 43% had a single lesion pattern, 40% had a scattered lesion pattern, and 17% had a multiple territory lesion pattern. In multivariable analysis, the categorical variable lesion pattern was independently associated with new DWI lesions (odds ratiomultiple territory lesion pattern, 3.64 [95% confidence interval, 1.75-7.58]; odds ratioscattered lesion pattern, 1.96 [95% confidence interval, 1.09-3.56]). Patients with multiple territory lesion pattern had significantly more often diabetes mellitus, and their new lesions were more often located remotely from the initial area of hypoperfusion compared with patients with scattered lesion pattern.
CONCLUSION
Lesion pattern on initial image is an independent risk factor for new DWI lesions. The risk for new DWI lesions is highest in patients with multiple territory lesion pattern.