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Evolution of acute lacunar lesions in terms of size and shape: a PICASSO sub-study

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Abstract

The imaging definition of lacunar infarcts is variable, particularly regarding their size and the presence of cavitation. We investigated the changes of diameter and evolution pattern of acute lacunar infarcts, and the factors associated with the evolution pattern. Patients with acute single subcortical hemispheric or brainstem ischemic lesions of penetrating arterial territories were included. Maximal diameters on initial diffusion-weighted image (DWI) and follow-up fluid-attenuated inversion recovery image (FLAIR), which performed > 12 months after initial DWI, were semi-automatically measured. Clinical characteristics were compared according to evolution patterns on follow-up FLAIR, classified as cavitated, focal lesion without cavitation, and disappeared. Five hundred nine patients were included. Mean time to follow-up was 31.3 ± 13.7 months. Mean diameter of acute lacunar lesions decreased from 12.9 ± 4.4 to 8.5 ± 4.8 mm during follow-up. Lesions of 58.2% patients remained as cavitated, 18.3% as focal lesion without cavitation, and 23.6% disappeared. Initial NIHSS score (p = 0.005), diameter of initial lesion (p < 0.001), number of slices showing acute lesion on DWI (p < 0.001), progression of white matter lesion (p < 0.001), number of acute lesions involving gray matter (p = 0.008) and lesion location (p < 0.001) were different among three groups. After adjustment for covariates, diameter of the acute lesion, initial number of old lacunes, and anterior lesion location were associated with the appearance of cavitation. Initial lesion diameter and posterior lesion location were associated with the disappearance. We observed reduction of the acute lacunar lesion diameter in 86%. There were predictive factors of disappearance and cavitation of acute lacunar infarction.

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Acknowledgements

PICASSO study was supported by Korea Otsuka Pharmaceutical Company. SU Kwon received Grants from Korea Otsuka Pharmaceutical Company.

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Author notes

  1. Hyuk Sung Kwon and A-Hyun Cho contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea

    Hyuk Sung Kwon

  2. Department of Neurology, Yeouido St. Mary’s Hospital, Catholic University of Korea, College of Medicine, Seoul, Republic of Korea

    A-Hyun Cho

  3. Department of Neurology, Myongji St. Mary’s Hospital, Seoul, Republic of Korea

    Min Hwan Lee

  4. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Dongwhane Lee & Sun U. Kwon

  5. Department of Neurology, Stroke Center, Yeungnam University Hospital, Daegu, Republic of Korea

    Da-Eun Jeong

  6. Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea

    Changwoon Choi

  7. Department of Neurology, Anyang Medical Center, Anyang, Republic of Korea

    Ji-wan Jang

  8. Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea

    Sungwook Yu

  9. Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea

    Jong-Ho Park

  10. Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea

    Sung Hyuk Heo

  11. Clinical Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Ji-Sung Lee

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  1. Hyuk Sung Kwon
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  2. A-Hyun Cho
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  11. Ji-Sung Lee
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  12. Sun U. Kwon
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PICASSO investigators

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Correspondence to Sun U. Kwon.

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The authors have no conflicts of interest to report.

Ethical standards

This study was approved by the ethics committee of each participating center and all participants were enrolled after written informed consent was obtained.

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Kwon, H.S., Cho, AH., Lee, M.H. et al. Evolution of acute lacunar lesions in terms of size and shape: a PICASSO sub-study. J Neurol 266, 766–772 (2019). https://doi.org/10.1007/s00415-019-09201-7

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  • DOI: https://doi.org/10.1007/s00415-019-09201-7

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