Imaging And Clinical Analysis In The Cardiogenic Cerebral Infarction

Objectives: Observe the imaging and clinical performance characteristics of the patients with cardiogenic cerebral infarction(CCI), discuss the imagining and related clinical factors influencing the curative effect and prognosis, and improve the diagnosis level of the CCI. Materials and methods: To retrospectively analyze the CCI patients in neurology in-patient department of Tianjin Union Medical Centre from Jan. 2012 to Oct. 2014. All patients examined carotid artery,vertebral artery by Toshiba APLL050SSA-700 A color doppler ultrasound. All patients examined by PHILIPS Achieve 1.5 T MR System with standard 16 RF-receiver channels respectively. With Axial, sagittal and coronal plane were scanned for localization. T1 WI, T2 WI, DWI, ADC, and 3D TOF MRA, FLAIR image modalities was performed. The CCI group was regarded as meeting the diagnosis standard about the acute cerebral embolism in Essentials of Diagnosis about Various Cerebrovascular Diseases of China Neuroscience Association, and CCI standard of TOAST, and having high and medium danger factors of the CCI. The CCI group was composed of 58 patients,34 men patients and 24 women patients,at the age from 49 to 91, average 73.72±10.12 years old.Other acute cerebral infarction belongs to the non-cardiogenic cerebral infarction group(non-CCI group).The non-CCI group was composed of 51 patients,36 men patients and 15 women patients,at the age from 52 to 88, average 67.53±10.36 years old.Recorded the size, amount and morbidity parts of the CCI, and carried out the inter-group comparison with the non-CCI, so as to determined the spatial distribution feature of the CCI. Further divided the patients with the CCI into corresponding vascular occlusion subgroup and corresponding vascular non-occlusion subgroup according to MRA data. Divided the patients into effective therapy, ineffective therapy and deterioration subgroup according to pre-therapy and post-therapy NIHSS grading. Compared the influence of the corresponding vascular occlusion, focus area and different circulation involvement on the curative effect of the CCI. Arranged follow-up visit towards some patients, and analyzed the clinical influence factors of the cerebral infarction recurrence. Results:1.In CCI group,large-area infarcts [33/58 cases,(56.90%)] were more than large-area infarcts of the non-CCI [18/51(35.29%)], the difference was statistical significance, P<0.05. The incidence rate of the CCI group[43/58,(74.14%)] was close to that of the non-CCI group[43/58,(74.14%)]. There was not statistical significance, P>0.05. The cerebral infarction type has some statistical relevance with the focus size. However, it does not have statistical relevance with the focus quantity.2.The most of CCI [39/58(67.24%)]fell into anterior circulating blood supply area,and single vascular involvement[ 33/58(56.90%)] were the most.Compared with the non-CCI group, there was not statistical significance, as cross-vascular(25cases, 43.1%vs.28 cases,54.9%).cross-circulatin(13cases,22.42%vs.13 cases,25.49%)and cross-bilateral cerebral hemisphere(5cases,12.82%vs. 3cases,8.57%), P>0.05.The single anterior circulating blood supply area in two groups were the MCA perforating artery infarct often. And the CCI group were more than non-CCI group(29/34,85.29%vs.17/32,53.13%). The difference was statistical significance, P<0.05. Single MCA blood supply area, there were mainly involved with cortical and subcortical infarct in CCI group(21/33,63.64%), compared with the non-CCI group(10/28,35.71%),the difference was statistical significance, P<0.05.3.MRA proved that there were 47(81.03%) of CCI presented the corresponding vascular didn’t occlusion, 11(18.97%) presented occlusion. There was no difference between vascular occlusion and vascular non-occlusion with infarction size in CCI group, P>0.05. The effective cases in the vascular occlusion subgroup were 4(36.36%) and ineffective cases were 2(18.18%), while the deterioration cases were 5(45.45%). In the vascular non-occlusion subgroup, the effective cases were 29(61.70%), ineffective cases were 15(31.91%) and deterioration cases were 3(6.38%). The difference was statistical significance, P<0.05. The patients with corresponding vascular occlusion had the high curative efficiency, the patients with the corresponding vascular occlusion had the low curative efficiency. The effective cases of large-area infarcts were 14(42.42%)and ineffective cases were 13(39.39%) while the deterioration cases were 6(18.18%). The effective cases of small-area and lacuna infarct were 19(76.00%)and ineffective cases were 4(16.00%) while the deterioration cases were 2(8.00%),the difference between the prognosis of the large-area infarcts with the small-area and lacuna infarct was statistical significance, P<0.05. The large area of CCI had the lower curative efficiency than small-area and lacuna infarct.No statistical correlation between different circulations of infarct involvement with the prognosis, P>0.05. Conclusion:1.The CCI was frequent in anterior circulating, multiple infarcts were the often.The focus were the similar with the non-CCI group as cross-vascular 、cross-circulating and cross-bilateral cerebral hemisphere.2.The CCI often presented as a large area of infarct. The large size of the cortical layer and subcortex infarction occurring in MCA blood supply area had some prompt effect on the CCI.3.The large area of CCI had the lower curative efficiency than the small-area and lacuna infarct.4.The corresponding vascular occlusion and the cerebral infarction size do not have the predictable significance. However, the corresponding vascular occlusion was helpful to predict curative effect. In general, the patients with the corresponding vascular occlusion had the relatively bad curative effect.