A High-resolution MRI Study Of Basilar Plaque On Pathogenesis Of Isolated Pontine Infarction

ObjectiveTo explore the pathogenesis in isolated pontine infarction based on the application of high-resolution magnetic resonance imaging(HRMRI)through comparative analysis of the clinical data,the basilar artery stenosis,the atherosclerotic plaque distribution and enhancement features in patients with paramedian pontine infarction(PPI),pontine lacunar infarcts(LPI)and patients without posterior circulation infarction,thus providing valuable guidance for clinical treatment and prevention of the disease.Materials and Methods1?Patient General Information:From Linyi People's Hospital,June 2014 to October2015,77 patients with acute or subacute isolated pontine infarctions were consecutively enrolled,including 50 males and 27 females,aged 45 to 74 years old.According to the maximum infarction diameter and location of infarction,48 cases of them were classified in the PPI group,29 cases in the LPI group,respectively.Thirty subjects attending our hospital for routine health examination without posterior circulation infarcts were attributed to the control group in the same period.Patients with histories of posterior circulation strokes,heart failure with a New York Heart Association degree 3 or 4,myocardial infarction,atrial fibrillation,rheumatic vascular heart disease,arteritis or confirmed diagnosis of such diseases during this study were excluded.2?MR Protocols:The subjects were imaged with a 3.0-tesla MR scanner(Siemens3.0-tesla Magnetom Verio,Germany).The whole brain was scanned,using whole body magnetic resonance scanner and 8 channel phased array quadrature head coil.The routine MR sequences,including T1WI,T2WI,FLAIR,DWI,3D-TOF MRA and HRMRI sequences,including DIR-SE-T1WI,FSE-T2WI were scanned.Enhanced MRI scan were also done on the patients with isolated pontine infarction.3?Image Review:All images were analyzed by two experienced physicians of diagnostic imaging blinded to the clinical information.The contents included the range of isolated pontine infarction,basilar artery stenosis,arterial plaque distribution and strengthening characteristics.4?Data Analysis:All our data were analyzed with SPSS(version 18.0).Categorical data were analyzed by?~2 test.Measurement data were analyzed by Student's t test.P<0.05 was considered to indicate statistical difference.Results1?There was no significant statistical difference between PPI and LPI groups in all the clinical risk factors(P>0.05).PPI group and LPI group were compared with the control group,in which age,hypertension,diabetes,hyperlipidemia differences were statistically significant(P<0.05),smoking and sex differences were not statistically significant(P>0.05).2?Comparison of basilar artery stenosis on the PPI group[37/48(77.08%)]and LPI group[22/29(75.86%)],the difference was not statistically significant(?~2=0.02,P=0.90,P>0.05).Comparison of basilar artery mild stenosis(?30%)on the PPI group[17/48(35.42%)]and LPI group[16/29(55.71%)],the difference was statistically significant(?~2=34.01,P=0.01,P<0.05).Separately comparison of basilar artery stenosis on the PPI group[37/48(77.08%)],LPI group[22/29(75.86%)]and control group[4/30(13.33%)],the differences were statistically significant(?~2=30.90 and 23.39,P<0.05).3?Comparison of basilar artery atherosclerotic plaques on the PPI group[34/48(70.83%)]and LPI group[20/29(68.97%)],the difference was not statistically significant(?~2=0.03,P=0.98,P>0.05).Separately comparison of basilar artery plaques on the PPI group[34/48(70.83%)],LPI group[20/29(68.97%)]and control group[2/30(6.67%)],the differences were statistically significant(?~2=28.56and 24.47,P<0.05).4?Comparison of basilar artery enhanced atherosclerotic plaques on the PPI group[28/34(82.35%)]and LPI group[16/20(80.00%)],the difference was not statistically significant(?~2=0.05,P=0.83,P>0.05).Conclusions1?There was no significant difference in clinical risk factors for PPI and LPI.2?The occurrence of isolated pontine infarction patients with basilar artery stenosis was higher.Mild basilar artery stenosis is more common in patients with LPI,moderate basilar artery stenosis is more common in patients with PPI.3?Atherosclerotic plaques found in LPI and PPI patients were mostly unstable plaques.4?Similar to the pathogenesis of the PPI,BAD also plays an important role in the incidence of LPI.