Features Of MRI Imaging Markers Of Cerebrovascular Diseases And It's Relationship With First Lacunar Infarction

Objective: The passage is intending to explore the influence of CSVD imaging markers for acute CSVD,the clinical application value of CSVD total load rate.At the same time,we are going to look for the may influence factors and the characteristics of image of first time lacunar cerebral infarction and compare clinical characteristics in patients with different total SVD score,so that we can treat reversible factors,correct all intervention risk factors.After we finish all of that,we can find out the methods of prevention and treatment in first time lacunar cerebral infarction patients.Research methods:We collected the clinical and radiographic data of patients who were admitted in neurology department for treatment in People's hospital LiaoNing province between September 2016 to May 2018.These patients were divided into two groups:the group 1 was those who were diagnosd with lacunar infarction based on clinical or cerebral MRI imaging feature;the group 2 was those who were diagnosed with non-lacunar infarction(normal MRI or diagnosed based on the marks of CSVD imaging features.Than we tempt to use a new concept recently proposed,the "total SVD score",which includs the lacuna,a wide range of WML(scores 2 or 3 points in deep chamber or 3 points in periventricular area in Fazekas score),deep cerebralmicrobleeds,moderately to severe EPVSs(EPVSs level for 2-4).Binary Logistic regression and multivariate ordered Logistic regression analysis were used to explore the possible independent risk factors between groups and within groups,and the characteristics of CSVD imaging markers in patients within and between groups were also analyzed.Results:(1)Binary Logistic regression analysis showed that smoking(P=0.002,OR=1.07,95%ci: 1.476-5.763),cholesterol level(P=0.008,OR=0.704,95%ci: 0.544 ~ 0.912)and total SVD score(P=0.000,OR=1.672,95%ci: 1.344 ~ 2.081)were still associated with the first lacunar infarction.Group 1 has more LIs,CMBs,extensive WMLs and moderate to severe EPVSs than group 2(all P < 0.01).Peripheral white matter lesion,deep white matter lesion and total Fazekas score in group 1 were significantly higher than those in group 2(all P<0.01).(2)Binary Logistic regression analysis of each imaging marker indicated that after the presence of other markers was adjusted,all the differences between the presence of any marker and other markers were significant(all P < 0.05).(3)The study between different groups of SVD score in first-episode patients with lacunar stroke shows that after adjusting the risk factors(including age,hypertension,admitted to hospital in time NIHSS score,HCY,FIB),orderly multiple logistic regression analysis points out that age(OR = 1.079,95% CI: 0.036 ~ 0.116),NIHSS score on admission(OR = 1.775,95% CI: 0.225 ~ 0.924),systolic blood pressure on admission(OR = 1.017,95% CI: 0.000 ~ 0.034),no high blood pressure(OR = 0.341,95% CI:-1.920 ~-0.230)had significant influence on the severity of SVD score(P < 0.05).The results of Spermen level correlation analysis of group 1 in differwet SVD score group indicate that age,hypertension,degree of hypertension,and NIHSS score on admission were positively correlated with SVD score(P < 0.05).(4)In different total SVD score groups of asymptomatic cerebral small vessel disease,multiple ordered logistic regression analysis showed that age(P=0.000,OR=1.075,95%ci: 0.047 ~ 0.098),no hypertension(P=0.001,OR=0.4,95%ci:-1.446 ~-0.391),and no atherosclerosis(P=0.02,OR=0.39,95%ci:-1.730 ~-0.147)were still independently correlated with severity of SVD score.The correlation analysis of Sperman grade find that the total SVD score was negatively correlated with the use of antiplatelet aggregation drugs(P=0.048,RR=-0.159)and lipid-lowering drugs(P=0.001,RR=-0.274)before admission in group 2 patients.Conclusion:(1)Smoking is an independent risk factor for first lacunar infarction.The probability of lacunar infarction increased by 1.627 times for every 1 point increase in total SVD score.Patients with lacunar infarction have more background CSVD imaging markers and higher white matter lesion Fazekas scores(nither periventricular or deep or overall).(2)Age of patients with first lacunar infarction,NIHSS score at admission,and systolic blood pressure at admission are risk factors for different SVD score severity;No hypertension was a protective factor for different SVD score severity.The higher the NIHSS score of the patients in this group upon admission,the heavier the background SVD load may be,which has a certain guiding effect on clinical work,especially in the absence of imaging data,the condition of patients can be predicted.(3)The degree of hypertension is positively correlated with total SVD score,which indicates that hypertension,as an important risk factor that can be changed,can reduce blood pressure as much as possible,which may be beneficial to the reduction of SVD load.(4)Risk factors for different severity of total SVD in patients with asymptomatic cerebral small vessel disease include age,hypertension,and atherosclerosis.While paying attention to CSVD,macrovascular lesions accompanied with it cannot be ignored.The patients in this group were treated with antiplatelet aggregation drugs and lipid-lowering drugs before admission,and the total SVD score was relatively small,which may suggest that the application of antiplatelet aggregation drugs and lipid-lowering drugs before admission is conducive to reducing the total SVD score of patients with non-lacunar cerebral infarction.(5)After the existence of other markers is adjusted,the existence of any marker is an independent risk factor for the existence of other markers.In clinical and research,it is not comprehensive to consider only one kind of lesion,so it is necessary to consider the lesion together.