近期皮质下小梗死患者深髓静脉可见性与血管周围间隙扩大及认知功能的相关性研究OA北大核心CSTPCD

Objective To explore the correlation between the visibility of intracranial deep medullary vein(DMV)and the enlarged perivascular space(EPVS)in different regions and cognitive function in patients with recent small subcortical infarct(RSSI).Methods This study retrospectively analyzed RSSI patients in the Department of Neurology,Changzhou Second People's Hospital Affiliated to Nanjing Medical University from October 2022 to October 2023,all of whom completed MRI and susceptibility-weighted imaging(SWI)sequence scans within 3 days after admission.Montreal cognitive assessment(MoCA)score of RSSI patients were evaluated within 7 days after onset.The EPVS grade and volume were evaluated for basal ganglia(BG)and centrum semiovale in all patients.The visibility of DMV on the patient's SWI magnitude images or minimum intensity projection map was evaluated.Patients were divided into low to medium DMV group with higher visibility(0-12 points,104 cases)and high DMV group with lower visibility(13-18 points,47 cases).Univariate analysis was used to compare clinical and imaging data between two groups of patients.Multivariate Logistic regression and Spearman correlation analysis were used to examine the relationship between the visibility of DMV and BG-EPVS grade and volume,as well as the relationship with patients'cognitive function.Results A total of 151 RSSI patients were included,with an average age of(69±10)years,including 92 males(60.9％)and 59females(39.1％).The age of RSSI patients in the high DMV group([76±5]years vs.[65±10]years,t=-10.875),as well as the proportion of hypertension(78.7％[37/47]vs.54.8％[57/104],x2=7.879),BG-EPVS grade,BG-EPVS volume(5.67[5.30,5.81]ln mm3 vs.4.61[3.66,5.30]ln mm3,Z=-6.772)and white matter hyperintensity(WMH)volume(7.67[6.23,8.43]ln mm3 vs.4.31[3.53,5.89]ln mm3,Z=-6.501)were significantly higher than those in the low to medium DMV group,and the differences were statistically significant(all P＜0.05).The total cholesterol(3.74[3.20,4.39]mmol/L vs.4.09[3.47,4.96]mmol/L,Z=-2.082),triglyceride(1.20[0.78,1.86]mmol/L vs.1.53[1.05,1.99]mmol/L,Z=-2.343),MoCA scores(21.0[20.0,22.0]points vs.24.0[22.0,25.0]points,Z=-9.862)of RSSI patients in the high DMV group were all lower than those in the low to medium DMV group(all P＜0.05).The differences in other baseline data were not statistically significant(all P＞0.05).The results of multivariate Logistic regression analysis showed that higher age(OR,1.181,95％CI 1.070-1.304,P=0.001),moderate to severe BG-EPVS(OR,2.441,95％CI 1.186-5.024,P=0.015),larger BG-EPVS volume(OR,4.987,95％CI 1.218-19.350,P=0.020)and larger WMH volume(OR,1.285,95％CI 1.044-1.582,P=0.018)was related to high DMV score.Spearman correlation analysis showed that DMV score was positively correlated with BG-EPVS grade in RSSI patients(r=0.613,P＜0.01),positively correlated with BG-EPVS volume(r=0.549,P＜0.01),and negatively correlated with MoCA score in RSSI patients(r=-0.449,P＜0.01).Conclusion Age,BG-EPVS grade,BG-EPVS volume and WMH volume are related to DMV visibility in RSSI patients;RSSI patients with lower visibility of DMV had more severe cognitive impairment.