Data_Sheet_1_Lacunar Stroke Lesion Extent and Location and White Matter Hyperintensities Evolution 1 Year Post-lacunar Stroke.docx

Lacunar strokes are a common type of ischemic stroke. They are associated with long-term disability, but the factors affecting the dynamic of the infarcted lesion and the brain imaging features associated with them, reflective of small vessel disease (SVD) severity, are still largely unknown. We investigated whether the distribution, volume and 1-year evolution of white matter hyperintensities (WMH), one of these SVD features, relate to the extent and location of these infarcts, accounting for vascular risk factors. We used imaging and clinical data from all patients [n = 118, mean age 64.9 (SD 11.75) years old] who presented to a regional hospital with a lacunar stroke syndrome within the years 2010 and 2013 and consented to participate in a study of stroke mechanisms. All patients had a brain MRI scan at presentation, and 88 had another scan 12 months after. Acute lesions (i.e., recent small subcortical infarcts, RSSI) were identified in 79 patients and lacunes in 77. Number of lacunes was associated with baseline WMH volume (B = 0.370, SE = 0.0939, P = 0.000174). RSSI volume was not associated with baseline WMH volume (B = 3.250, SE = 2.117, P = 0.129), but predicted WMH volume change (B = 2.944, SE = 0.913, P = 0.00184). RSSI location was associated with the spatial distribution of WMH and the pattern of 1-year WMH evolution. Patients with the RSSI in the centrum semiovale (n = 33) had significantly higher baseline volumes of WMH, recent and old infarcts, than patients with the RSSI located elsewhere [median 33.69, IQR (14.37 50.87) ml, 0.001 ≤ P ≤ 0.044]. But patients with the RSSI in the internal/external capsule/lentiform nucleus experienced higher increase of WMH volume after a year [n = 21, median (IQR) from 18 (11.70 31.54) ml to 27.41 (15.84 40.45) ml]. Voxel-wise analyses of WMH distribution in patients grouped per RSSI location revealed group differences increased in the presence of vascular risk factors, especially hypertension and recent or current smoking habit. In our sample of patients presenting to the clinic with lacunar strokes, lacunar strokes extent influenced WMH volume fate; and RSSI location and WMH spatial distribution and dynamics were intertwined, with differential patterns emerging in the presence of vascular risk factors. These results, if confirmed in wider samples, open potential avenues in stroke rehabilitation to be explored further.

腔隙性脑卒中是一种常见的缺血性卒中类型。此类卒中与长期残疾相关，然而，影响梗死灶动态变化及与其相关的脑影像学特征（反映小血管疾病（SVD）严重程度）的因素，仍 largely 未知。本研究旨在探讨白质高信号（WMH）这一SVD特征在分布、体积及1年内演变方面，是否与梗死灶的范围和位置相关，并考虑血管风险因素。我们收集了2010年至2013年间，在区域性医院因腔隙性卒中综合征就诊且同意参与卒中机制研究的118名患者[平均年龄64.9岁（标准差11.75）]的影像学和临床数据。所有患者在就诊时均接受脑部MRI扫描，其中88名患者在12个月后进行了再次扫描。在79名患者中发现了急性病灶（即近期的小皮质下梗死，RSSI），在77名患者中发现了腔隙。腔隙数量与基线WMH体积（B = 0.370，SE = 0.0939，P = 0.000174）相关。RSSI体积与基线WMH体积无关联（B = 3.250，SE = 2.117，P = 0.129），但预测WMH体积变化（B = 2.944，SE = 0.913，P = 0.00184）。RSSI的位置与WMH的空间分布和1年内WMH演变模式相关。在半卵圆中心（n = 33）的RSSI患者，其基线WMH体积、近期和陈旧性梗死体积显著高于其他位置的RSSI患者[中位数33.69，四分位数间距（14.37-50.87）ml，0.001 ≤ P ≤ 0.044]。但内部/外部囊/豆状核的RSSI患者在一年后WMH体积增加更为明显[21名患者，中位数（四分位数间距）从18（11.70-31.54）ml增加到27.41（15.84-40.45）ml]。对按RSSI位置分组患者的WMH分布进行体素分析，发现血管风险因素（尤其是高血压和近期或当前吸烟习惯）的存在使得组间差异增加。在我们的样本中，就诊的腔隙性卒中患者的腔隙性卒中范围影响了WMH体积的走向；RSSI位置与WMH的空间分布和动态变化相互交织，在血管风险因素存在的情况下，呈现出不同的模式。这些结果，若在更大样本中得到证实，将为卒中康复领域开辟新的研究途径。