Study On Clinical-DWI Mismatch Related With Progressive Cerebral Infarction

Objective The morbidity and mortality rates of progressive cerebralinfarction are higher than ordinary infarction, which is one of the importantreasons that could affect the prognosis of patients and also the difficulty of theprevention and treatment. This study is to find some possible predictive and riskfactors of progressive cerebral infarction by comparison and analysis of theclinical-DWI mismatch(CDM) and the other related factors in patients withprogressive cerebral infarction, which can provide some relevant informations forclinical early detection, prevention and treatment of progressive cerebralinfarction.Methods120patients with acute cerebral infarction in hospital no morethan24hours were selected, from January to September2012, at the AffiliatedHospital of Ningxia Medical University Department of Neurology. According towhether cerebral infarction were progressed after admission or not, the patientswere divided into PCI group,27cases, and non-progression group,93cases. Thegeneral information of the both groups were noted, including age, gender, historyof hypertension, diabetes, hyperlipemia and smoking; the laboratory indicatorswere recorded, including temperature, routine blood test, fasting glucose,triglyceride(TG), total cholesterol(TC), fibrinogen (FIB); The DiffusionWeighted Imaging (DWI) has been accomplished after admission, According tothe NIHSS and Alberta Stroke Program Early CT Score (ASPECTS), to analyzethe relationship between CDM and occurrence of PCI; According to the infarction location,120cases were divided into periventricular infarction group, watershedinfarction group, cerebral lobal infarction group, basal ganglia infarction groupand massive infarction group, then compared the percentage of progressivecerebral infarction in each group; MR angiography (MRA) and Carotid colordopplar ultrasound were used to evaluate stenosis or occlusion of middle cerebralartery(MCA) or internal carotid artery (ICA)，to analyze the relationship with PCI.Results1.There were no significant difference in age, gender, history ofhypertension, diabetes, hyperlipemia and smoking(P>0.05).2. The NIHSS score ofPCI group on admission was7.7±1.6, and non-progression group was4.7±2.3.PCIgroup was higher than non-progression group, there was statistically significantdifference between the two groups(P<0.01); There was no significant differencebetween PCI group and non-progression group in ASPECTS score, temperature,white blood cell count, fibrinogen(FIB), triglyceride(TG), total cholesterol(TC);PCI group was higher than non-progression group in blood glucose, there wasstatistically significant difference between the two groups(P<0.01).3. CDM wasobserved in120cases，14cases in PCI group (14of27cases,63.0%) and13casesin non-progression group(13of93cases,16.3%), there was statisticallysignificant difference between the two groups(P<0.001).4.27cases in the PCIgroup, there were8cases in the periventricular infarction group(29.6%),9cases inthe watershed infarction group(33.3%),5cases in the cerebral lobe infarctiongroup(18.5%),3cases in the basal ganglia infarction group(11.1%) and2cases inthe large infarction group (7.4%);93cases in the non-progression group, therewere13cases in the periventricular infarction group(14.0%),12cases in thewatershed infarction group (12.9%),27cases in the cerebral lobe infarction group(29.0%),35cases in the basal ganglia infarction group(37.6%) and6cases in thelarge infarction group(6.5%), the cerebral infarction position in the periventricular or watershed area has the higher incidence of PCI.5. The stenosis or occlusion ofMCA diagnosed by MRA was observed in11cases in PCI group (11of27cases,40.7%) and18cases in non-progression group(18of93cases,19.4%), there wasstatistically significant difference between the two groups(P<0.05).6.Multivariate logistic regression analysis showed that clinical-DWI mismatch(CDM), stenosis or occlusion of middle cerebral artery could be independentrisk predictors of PCI.Conclusion1. Huperglycemia was risk frelated factor of progressivecerebral infarction.2. The PCI group with a higer score of NIHSS also has ahigher level of periventricular or watershed infarction, Which shows an earlywarning significance for the progressive cerebral infarction.3. The clinical-DWImismatch(CDM), stenosis or occlusion of MCA showed in MRA could effectivelypredict the occurrence of progressive cerebral infarction.