Imaging Evolution Of Acute Small Subcortical Infarction And Its Relative Factors

Objective: To investigate imaging evolution of acute small subcortical infarction(ASSI)and its relative factors.Methods: We retrospectively enrolled 123 patients with ASSI,admitted to the department of neurology,People's Hospital of China Medical University from April 2016 to November 2019.There were 93 males and 30 females,with mean age 66.22 ± 11.88 years.The outcomes of imaging evolution of ASSI were divided into three types: cavitation,white matter hyperintensities(WMHs)group and non-visible.Cerebrovascular risk factors,clinical data at admission,baseline brain imaging characteristics on MRI were recorded analyzed.Results: Of the 123 patients included,ASSI of 93 patients(75.6%)evolved into cavitation,ASSI of 9 patients(7.3%)evolved into WMHs(7.3%),and ASSI of 21 patients(17.1%)were non-visible.The follow-up interval was 303(125-390)days.The Kappa was 0.765 in consistent tests between the two neurologists(P<0.001)on the evaluation of outcomes of imaging evolving.(1)In comparison with patients of non-cavitation,the patients of cavitation had lower level of hyperlipemia [39(42.4%)versus 21(70.0%)],shorter of baseline and follow-up MRI time interval [288(112.50-363.00)versus 362.00(268.25-465.00)],larger infarct diameter on baseline DWI [10.20mm(7.58-13.29)versus 8.45mm(4.96-10.16)],and higher score of baseline old lacunar infarct[2.00(1.00-2.00)versus1.00(1.00-2.00)].Logistic regression analysis showed that hyperlipidemia(OR = 0.279,95% CI: 0.102 0.764,P = 0.013),infarct diameter on baseline DWI(OR=1.250,95%CI1.078-1.451,P=0.003)and score of baseline old lacunar infarct(OR=3.437,95%CI:1.493-7.914,P=0.004)were independent risk factor for patients of cavitation.(2)In comparison with patients of cavitation,the patients of infarction lesion disappearance group had higher proportion of coronary heart disease [(8(38.1%)versus 12(12.9%)]and hyperlipidemia [15(71.4%)versus 39(42.4%)],smaller infarct diameter on baseline DWI [7.50(4.65-9.85)versus 10.20(7.58-13.29)],and lower score of baseline old lacunar infarct [1.00(1.00-2.00)versus2.00(1.00-2.00)],Multivariate logistic regression analysis showed that hyperlipidemia(OR=0.258,95%CI:0.078-0.850,P=0.026)?infarct diameter on baseline DWI(OR=0.706,95%CI: 0.579-0.861,P=0.001)and score of baseline old lacunar infarct(OR=0.202,95%CI:0.077-0.531,P=0.001)were independent risk factor for patients of infarction lesion disappearance group.(3)In comparison with patients of cavitation,the patients of WMHs group had longer baseline and follow-up MRI time interval [399.00(317.00-510.50)versus 228.00(112.50-363.00)].Multivariate logistic regression analysis showed that baseline and follow-up MRI time interval were independent risk factor for patients of WMHs group.Conclusions: 75.6% of small acute subcortical infarcts developed into old lacunar infarcts,17.1% disappeared,and 7.3% developed into WMHs.Larger diameter of baseline DWI lesions and higher score of baseline lacunar cerebral infarction were independent influencing factors for the evolution of acute subcortical small infarction lesions into old lacunar infarction lesions.