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• Clinical Article •
The TOAST classification and imaging characteristics in acute cerebral infarction with different treatment methods
REN Jun  JIANG Liang  YIN Xin-dao  CHEN Hui-you  PENG Ming-yang  CHEN Song-wang  MAO Cun-nan  ZHOU Jun-shan  ZHANG Ying-dong 

DOI:10.12015/issn.1674-8034.2017.08.001.


[Abstract] Objective: To analyze the imaging features of acute cerebral infarction with different therapies using multi-mode magnetic resonance diffusion weighted imaging-perfusion weighted imaging.Materials and Methods: One hundred and ten patients admitted to our hospital neurology department with acute cerebral infarction were retrospectively analyzed. All patients were performed multi-mode magnetic resonance examination, the imaging findings, clinical data and laboratory findings were recorded. The diffusion weighted imaging (DWI) and trial of org 10172 in acute stroke treatment (TOAST) of patients were classified according to them. The patients were divided into vein thrombolysis group (43 cases), artery bolt group (34 cases) and conservative treatment group (33 cases), and the imaging and clinical data of three groups were statistically analyzed.Results: (1) The ratio of ischemic penumbra and hyperintense vessel in artery bolt group were higher than the ratio of vein thrombolysis and conservative treatment group, and the difference had statistical significance (F=13.713, P=0.001; F=8.108, P=0.017). (2) In terms of DWI classification, the small penetrating branch infarction and unilateral anterior circulation infarction for lager ratio in vein thrombolysis group (25.58%, 23.26%), unilateral anterior circulation infarction and anterior-posterior circulation infarction for larger ratio in artery bolt group (52.94%, 21.43%) and conservative treatment group (30.30%, 30.30%). (3) In terms of TOAST classification, LAA for larger ratio in vein thrombolysis group (39.53%), UND for lager ratio in artery bolt group, SAO for conservative treatment group. (4) In terms of MRA imaging findings, both middle cerebral artery and internal carotid artery showed the highest proportion of normal in intravenous thrombolysis and conservative treatment group (72.09%, 51.52%), and middle cerebral artery stenosis or occlusion showed the highest proportion in artery bolt group (41.18%). (5) Artery bolt group had the highest bleeding conversion rate in the three groups (26.47%), the difference was statistically significant (F=6.462, P=0.040). (6) Hospital NIHSS score and hyperlipidemia in the three groups had statistical difference (t=6.209, P=0.003; F=6.176, P=0.046). (7) the onset time in conservative treatment group (6.55±4.70) was longer than that in intravenous thrombolysis group (2.93±1.05) and artery bolt group (3.07±2.51). There were significant differences in three groups (t=16.246, P=0.000).Conclusion: Knowledge of the imaging findings of patients with different treatment characteristics, can help clinical doctors choose reasonable treatment scheme according to the concrete situation, realize the personalized treatment.
[Keywords] Cerebral infarction；Magnetic resonance imaging；Diffusion weighted imaging；Perfusion weighted imaging；TOAST classification

REN Jun Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

JIANG Liang Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

YIN Xin-dao* Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

CHEN Hui-you Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

PENG Ming-yang Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

CHEN Song-wang* Department of Function, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

MAO Cun-nan Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

ZHOU Jun-shan Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

ZHANG Ying-dong Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

*Correspondence to: Chen SW, E-mail: 1289353337@qq.com Yin XD, E-mail: y.163yy@163.com

Conflicts of interest   None.

ACKNOWLEDGMENTS  This work was part of Health and Family Planning Commission of Jiangsu Province No. H201541 Science and Technology Commission of Nanjing No. 201402046, 201503021
Received  2017-02-25
Accepted  2017-06-12
DOI: 10.12015/issn.1674-8034.2017.08.001
DOI:10.12015/issn.1674-8034.2017.08.001.

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