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Brain and Nerve No to Shinkei Volume 55, Issue 12 （December 2003）

Brain and Nerve 脳と神経 55巻12号（2003年12月発行）

Japanese English

原著

ラクナ梗塞と鑑別を要する多発性皮質下小梗塞―MRI拡散強調画像による検討― Multiple Small Subcortical Infarction Required to Distinguish from Lacunar Infarction : Evaluation by Use of Diffusion-weighted Imaging 橋本祐治 ^1,2 , 金子高久 ¹ , 大瀧雅文 ¹ Yuji Hashimoto ^1,2 , Takahisa Kaneko ¹ , Masafumi Ohtaki ¹ ¹帯広厚生病院脳神経外科 ²現　市立函館病院脳神経外科 ¹Department of Neurosurgery, Obihiro Kosei General Hospital ²Department of Neurosurgery, Hakodate Municipal Hospital キーワード： diffusion-weighted imaging , lacunar infarction , embolic stroke Keyword: diffusion-weighted imaging , lacunar infarction , embolic stroke pp.1041-1046

発行日 2003年12月1日 Published Date 2003/12/1

DOI https://doi.org/10.11477/mf.1406100572

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Abstract 文献概要
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要旨　MRI拡散強調画像（diffusion-weighted imaging：DWI）を利用し，ラクナ梗塞と鑑別を要する多発性皮質下小梗塞について検討を行った。対象はラクナ症候群を呈し皮質下小梗塞を認めた連続53症例で，そのうち9例（17.0％）に複数の高信号域がDWIで確認され，塞栓機序による穿通枝梗塞と診断した。病変部位は4例で単一，5例で複数の血管支配領域に存在した。推測した塞栓源は心臓・大動脈弓部が5例，頸部頸動脈が2例，頭蓋内頸動脈と椎骨動脈が1例ずつであった。単一ラクナ梗塞との比較では高齢者に多く，高血圧症が少ない傾向にあったが両者に有意差は認めなかった。描出された高信号域はDWIの38病変に対し，conventional MRIでは35病変であったが，後者単独では多発性病変の診断自体が困難であった。塞栓性穿通枝梗塞はDWIにより初めて認知され得る所見であり，この認識は治療法の選択や再発予防のための病因検索に影響を及ぼすと考えられる。

Abstract

Lacunar infarctions are small lesions caused by occlusion of the deep and penetrating vessels. Occlusion of such vessels are resulted from thrombosis based on atherosclerotic change. However, we occasionally encounter a patient with lacunar infarction seemed to be caused by embolic mechanism, as who has had previous experience of TIA or presented with clinical symptoms suddenly.

Diffusion-weighted imaging（DWI）has high accuracy for depicting small ischemic lesions and discrimination of recent infarctions from old ones. We studied frequency, risk factors and stroke mechanism in the territory of penetrating arteries detected on DWI, and sensitivity of ischemic lesions by DWI as compared with conventional MRI images.

Fifty-three consecutive patients with lacunar infarction in the territory of penetrating arteries who admitted to our hospital and were studied by DWI within 24 hours. Nine（17.0％）of 53 patients had multiple high signal lesions on DWI. These lesions were found in single arterial territory in 4 patients and in more than 2 territories in 5 patients. It was presumed that stroke mechanisms were artery to artery or cardiogenic embolism. DWI revealed all 38 hyperintensity lesions, while conventional MRI revealed 35 lesions, although the latter was resulted from retrospectively referring to the DWI finding. Therefore, conventional MRI alone might have been difficult to detect multiple lesions.

DWI was enable to distinguish embolic infarction from small vessel lacunar infarction, leading to feasible patient management. Therefore, DWI should be performed in all patients with lacunar infarction, even if neurological finding is correspondent with the conventional MRI finding.

（Received : August 7, 2003）