Different Characteristics of Incidental DWI-positive Lesions and RSSI in Patients with Cerebral Small Vessel Disease
Ziang Pan1, Ming Yao1, Zi-Yue Liu1, Xingqi Pan1, Lixin Zhou1, Jun Ni1, Fei Han1, Yi-Cheng Zhu1
1Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science
Objective:
We aim to investigate the potential mechanisms of recent small subcortical infarct (RSSI) and incidental diffusion-weighted image (DWI)-positive lesions.
Background:
It remains unclear why some acute infarctions in patients with cerebral small vessel disease (CSVD) manifest as symptomatic strokes, whereas others accumulate covertly.
Design/Methods:
Based on the multicenter CSVD Disability and Outcome Cohort Study (DOC), we consecutively enrolled patients presenting with an acute lacunar stroke within 30 days; or patients without acute stroke symptoms but with moderate to severe white matter hyperintensities (WMH). Between August 2016 and June 2019, 1710 patients were recruited across 30 hospitals in China. We compared the clinical and imaging characteristics, lesion topography, associations with CSVD markers, 90-day stroke recurrence, and cognitive performance between individuals with incidental DWI-positive lesions and those with RSSI.
Results:
Among 1710 participants, (mean age 61.87±11.28 years, 37.25% female), the prevalence of incidental DWI-positive lesions and RSSI was 2.28% and 31.64%. Patients with incidental DWI-positive lesions were older, had lower blood pressure and lipid levels, and a higher prevalence of prior lacunar stroke. Incidental DWI-positive lesions were typically smaller and round/ovoid, more often involved the subcortical white matter, cerebral cortex and cerebellum. RSSI more frequently affected perforating artery territories, 39.9% of RSSI cases were consistent with branch atheromatous disease (BAD). Incidental DWI-positive lesions patients had a higher risk of 90-day recurrent stroke (HR=8.28, 95%CI=1.96-34.90, Log-rank p<0.001). They also had lower MMSE scores after adjustment for age and sex, although this difference was attenuated after additional adjustment for education and vascular risk factors.
Conclusions:
In contrast with Western populations, atherosclerosis and BAD may be common etiologies of RSSI in Chinese patients with CSVD. Incidental DWI-positive lesions, likely reflecting intrinsic small vessels injury, should be recognized as a CSVD marker and may have prognostic value for stroke recurrence and cognitive decline.
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