Neurological deterioration in small vessel disease may be associated with increase of infarct volume.
OBJECTIVE
The mechanism of neurological deterioration in small vessel disease is unclear. We examined the relationship between neurological deterioration and change of infarct volume in acute small vessel disease.


METHODS
We studied consecutive patients with acute supratentorial small vessel disease. Patients were classified into two groups (D: group with deterioration, N: group with no deterioration). We performed serial MRI studies, measured infarct volumes using NIH Image, and calculated the changes in infarct volume (Delta volume) between initial and follow-up diffusion-weighted imaging (DWI).


RESULTS
Seventy-two patients (44 males, 68+/-11 years of age) were enrolled. Fifteen patients exhibited neurological deterioration (group D) and 57 patients did not (group N). Initial infarct volume was 0.66 cm3 in group D and 0.45 cm3 in group N (p=0.025). Infarct volumes on follow-up DWI were 1.41 cm3 and 0.72 cm3, respectively (p=0.001). The Delta volume in group D was larger than that in group N (0.76 cm3 vs 0.27 cm3, p=0.001). In order to differentiate D from N group, sensitivity specificity analysis yielded a cut-off value of Delta volume of 0.5 cm3 for differentiation of the two groups, which exhibited a sensitivity of 80% and specificity of 84%. Multivariate logistic regression analysis demonstrated that increase in infarct volume of over 0.5 cm3 (odds ratio; 18.0, 95% CI; 1.4 to 270, p=0.027) was independently associated with neurological deterioration in patients with acute small vessel disease.


CONCLUSIONS
Enlargement of infarct volume may contribute to neurological deterioration in acute small vessel disease.
Terasawa
Yuka
Y
Department of stroke medicine, Kawasaki medical school 577 Matsushima Kurashiki-City, Okayama, 701-0192, Japan. tera@med.kawasaki-m.ac.jp
Iguchi
Yasuyuki
Y
Kimura
Kazumi
K
Kobayashi
Kazuto
K
Aoki
Junya
J
Matsumoto
Noriko
N
Shibazaki
Kensaku
K
Inoue
Takeshi
T
Kaji
Ryuji
R
D000368:Aged; D000369:Aged, 80 and over; D002544:Cerebral Infarction / Q000150:complications*; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012044:Regression Analysis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric