急性皮质下小梗死的影像学特征：大动脉粥样硬化性与小动脉病变性卒中的比较

Imaging features of acute small subcortical infarcts： comparison of large artery atherosclerotic and small artery disease stroke

目的探讨大动脉粥样硬化与小动脉病变所致皮质下小梗死（small subcortical infarction，SSI）的影像学差异。方法连续住院的急性SSI患者根据循证缺血性卒中病因分型（SSS-TOAST）标准分为大动脉粥样硬化性卒中组和小动脉闭塞性卒中组，比较其影像学特征。结果共纳入118例急性SSI患者，剔除7例为心源性脑栓塞，3例为其他明确病因所致卒中，7例为原因不明性卒中。26例大动脉粥样硬化性卒中组新发梗死灶平均（3．69±5．79）个，50％为多个病灶，以半卵圆中心为主（P〈0．01）；75例小动脉闭塞性卒中组新发梗死灶平均（1．08±0．51）个，仅3例（3．7％）为多个病灶，且位于不同动脉供血区。与大动脉粥样硬化性卒中组相比，小动脉闭塞性卒中组脑白质病变程度较重（P=0．04）、多伴有无症状梗死（P=0．012）。结论大动脉粥样硬化性SSI多为半卵圆中心的多发性梗死，而小动脉闭塞性SSI则多为单发性梗死，易伴严重的脑白质病变和无症状梗死。

Objective To investigate the differences in neuroirnaging between large artery atherosclerosis and small subcortical infarction （SSI）. Methods The consecutive hospitalized patients with acute SSI were divided into large atherosclerotic stroke group and small-artery occlusive stroke group according to the evidence-based etiologic classification of ischemic stroke （the SSS-TOAST criteria）. The neuroimaging features between the two groups were compared. Results A total of 118 patients with SSI were recruited. Seven patients with cardiogenic cerebral embolism were excluded from the study. Three were stroke of other determined etiology and 7 were cryptogenic stroke. Twenty-six patients in the large artery atherosclerotic stroke group had new infarcts （3.69 ± 5.79）, 50% of them were multiple lesions, mainly a half oval in the center （P 〈0. 01）; 75 patients in the small-artery occlusive stroke group had new infarcts （1.08 ± 0. 51）, only 3 （3.7%） were multiple lesions, and they were in the different artery territories. Compared to the large atherosclerotic stroke group, the white matter lesions was more severe in the small-artery occlusive stroke group （P = 0. 04）, and most of them were accompanied by silent infarction （P = 0. 012）. Conclusions The large atherosclerotic SSI was mostly multiple infarcts in a half oval in the center, while the small artery occlusive SSI was mostly single infarct, and was usually accompanied by severe white matter lesions and silent infarction.