急性孤立性脑桥梗死病灶模式与病因学机制的相关性

Correlation between lesion pattern and etiological mechanism in acute isolated pontine infarction

目的探讨急性孤立性脑桥梗死病灶模式与病因学机制的相关性。方法回顾性收集急性孤立性脑桥梗死患者的临床资料，应用弥散加权成像（diffusion-weighted imaging，DWI）确定病灶分布模式，分析病灶模式与病因学分型之间的相关性。结果总共纳入146例急性孤立性脑桥梗死患者，单侧梗死138例，双侧梗死8例。DWI病灶模式分析显示，旁正中梗死98例，前外侧梗死11例，被盖部梗死18例，多发性梗死19例；在各病因学分型中，基底动脉分支病变（basilar artery branch disease，BABD）所占比例最高（72例，49．3％），其次是大动脉闭塞性疾病（32例，21．9％）、小动脉闭塞性疾病（25例，17．1％）和其他病因／病因不明（12例，8，2％），心源性栓塞最少（5例，3．4％）。急性孤立性脑桥梗死的DWI病灶分布模式与病因学分型存在显著相关性（C=0．516，P〈0．001）。其中，60例旁正中梗死（χ2=16．915，P〈0．001）、1例前外侧梗死（χ2=7．701，P=0．006）、1例被盖部梗死（χ2=17．401，P〈0．001）与BABD显著相关；9例旁正中梗死（，=12．534，P〈0．001）、6例前外侧梗死（χ2=24．365，P〈0．001）、10例被盖部梗死（χ2=18．312，P〈0．001）与小动脉闭塞性疾病有关。结论急性孤立性脑桥梗死病灶模式与其病因学机制存在显著相关性，早期可通过DWI显示的梗死灶分布特征来预测急性孤立性脑桥梗死的病因。

Objective To investigate the correlation between lesion pattern and etiological mechanism in acute isolated pontine infarction.Methods The clinical data in patients with acute isolated pontine infarction were collected retrospectively. Diffusion weighted imaging （DWI） was used to identify the lesion patterns. The correlation between the lesion pattern and etiological subtype was analyzed. Results A total of 146 patients with acute isolated pontine infarction were enrolled in the study, including 136 unilateral infarctions and 8 bilateral infarctions. The DWI lesion pattern analysis showed that there were 98 patients with paranasal infarction, 11 with anterolateral infarction, 18 with tegmentum infarction, and 19 with multiple infarction. Among all the etiological subtypes, basilar artery branch disease （BABD） accounted for the greatest proportion （n= 72, 49. 3%）, followed by large arterial occlusive disease （n = 32, 21.9%）, small arterial occlusive disease （n= 25, 17.1%）, and other causes/unknown causes （n= 12, 8.2%）. Cardioembolism was minimal （n =5, 3.4%）. The distribution patterns of DWI lesions in acute isolated pontine iofarction were significantly correlated with the etiological subtypes （C= 0. 516, P〈 0. 001）. Among them, 60 patients with paramedian infarction （χ2 = 16. 915, P 〈0. 001）, 1 with anterolateral iofarction （χ2 =7. 701, P = 0. 006）, 1 with tegmentum infarction （χ2 = 17. 401, P 〈0. 001） were closely associated with BABD; 9 patients with paramedian infarction （χ2 =12.534, P 〈0. 001）, 6 with anterolateral infarction （χ2 =24.365, P 〈0.001）, and 10 with tegmentum infarction （χ2 = 18. 312, P〈0. 001） were significantlyassociated with small arterial occlusive disease. Conclusions There are significant correlation between the lesion pattern and etiological mechanism in acute isolated pontine infarction. The cause of acute isolated pontine infarction can be predicted in early stage by DWI revealed infarction distribution characteristics.