| Background and purpose:Impaired ischemic stroke(IS)is known as cryptogenic stroke(CS).In 2016,CS accounted for nearly 30%of all US IS,while 40%-50%of CS had patent foramen ovale(PFO).As an exclusionary diagnosis,CS often begins to exclude other stroke causes after MRI on the head MRI.This study was a retrospective study.The purpose was to provide advanced imaging clues for PFO screening by analyzing the cranial MRI features of CS with and without PFO.Methods:We retrospectively collected 66 cases of CS patients with PFO in our hospital from January 2008 to April 2016 as the case group,namely CS-PFO~+group;randomly selected 93 patients with ischemic cerebral infarction without PFO within one year of 2017 As a control group,the IS-PFO~-group.For the analysis of age factors,those aged<45 years were considered as a youth subgroup,including the CS-PFO~+(<45Y)group and the IS-PFO~-(<45Y)group.According to the severity of the right-to-left shunt,the CS-PFO~+patients were divided into three subgroups:mild shunt,moderate shunt,and severe shunt.Comparing the imaging features of cranial MRI in each group of patients,recording the number,distribution location of the infarcted foci,and the regional characteristics of the cerebral blood vessels involved,and analyzing the CS-PFO~+and IS-PFO~-and CS-PFO~+(<45Y)subgroups.Analysis what is the difference on Infarct characteristics,watershed distribution,and infarct characteristics of the different shunt subgroups within the case group,lesion load(ie number of infarcts),and risk of paradoxical embolism(ROPE)in the IS-PFO~-(<45Y)subgroup.Results:1.There was no statistically significant difference in gender,smoking history,and stroke history between the two groups(p>0.05).The age of patients in the CS-PFO~+group was lower than that in the IS-PFO~-group,and the IS-PFO~-group had hypertension,The incidence of diabetes and dyslipidemia was higher in the CS-PFO~+group(p<0.05).2.The distribution of infarct focus on MRI in both groups showed a statistically significant difference in the distribution of lesions in the watershed region(p<0.05):The incidence of infarcts in the post-corticocrine region was higher in the CS-PFO~+group than in the IS-PFO~-group;In the PFO~-group,the incidence of infarct foci in the cortical region was higher than that in the CS-PFO~+group,whereas in the subgroup of less than 45 years,the distribution of the infarct foci on the MRI was characterized by the CS-PFO~+(<45Y)in the group of brain-draining cerebral infarction.The incidence of single infarcts<15 mm below the cortex was higher than that of IS-PFO~-(<45Y),with a statistically significant difference(p<0.05).There was no statistical difference in the incidence of lesions in the two components of the watershed(p>0.05).3.The distribution of infarct focus in the circulatory drainage area of MRI images in both groups and their subgroups less than 45 years old showed that the incidence of infarcts in the left anterior circulation of the CS-PFO~+group was higher than that of the IS-PFO~-group.The difference was statistically significant(p<0.05).4.The distribution of arterial bifurcation in the infarct focus of the two groups on the MRI image showed that the prevalence of infarcts in the anterior cerebral artery was higher in the CS-PFO~+group than in the IS-PFO~-group,with statistically significant differences(p<0.05)..5.There was no statistical difference in the distribution of infarcts on the MRI,the number of infarctions,and the ROPE score in patients with mild shunt,moderate shunt,and severe shunt.Conclusion:1.There are differences in the cranial MR imaging characteristics between patients with CS-PFO~+and IS-PFO~-groups.Intracoronary infarcts in the left anterior circulation,infarcts in the anterior cerebral artery,infarcts in the posterior cortex,and single infarcts<15 mm below the cortex are recommended for PFO-related examinations.2.The distribution of infarcts on MRI,number of infarcts,and ROPE score did not reflect the severity of PFO shunts. |
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