Purpose

Despite considerable published information about the clinical–radiological correlation of medullary infarcts, no study has determined whether topographic evaluations are performed accurately among researchers. Our purpose in this study was twofold: to evaluate the topographic pattern of medullary infarcts on diffusion-weighted imaging by their radiological aspect, and to assess interobserver agreement on the topographic pattern.

Methods

We retrospectively reviewed our imaging and clinical database for patients admitted to our radiology department between January 2014 and September 2019. Two radiologists evaluated the imaging studies independently. Consensus data were used in the analysis.

Results

The retrospective review yielded 92 patients with medullary infarction. The affected vascular territories were lateral (n = 58), anteromedial (n = 28), posterior (n = 3), and anterolateral (n = 1). Two patients had hemimedullary infarction. The rostrocaudal levels of the medullary infarct were superior (n = 34), middle (n = 31), inferior (n = 4), superior-middle (n = 13), and middle-inferior (n = 10). The medullary infarcts were divided into two types: lateral (n = 62) and medial (n = 28). The affected vascular territories differed with rostrocaudal topography of medullary infarct (p = 0.003). Excellent interobserver agreement was found for type of medullary infarct, compared with moderate for vascular territory and fair for rostrocaudal topography. The anterolateral and posterior territories were the most often misdiagnosed, while the level with the most disagreements in rostrocaudal topography was middle.

Conclusion

The accurate topographic evaluation of a medullary infarct can be an important basis for investigating stroke etiology. However, correct topographic evaluation may not always be available and smaller territories such as anterolateral and posterior should be assessed carefully.

中文翻译：

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从放射科医生的角度对延髓性梗塞进行地形评估。

目的

尽管已发表了大量有关髓样梗死的临床影像学相关信息，但尚无研究确定研究人员是否正确进行了地形评估。我们在这项研究中的目的是双重的：通过放射学方面评估弥散加权成像上的延髓梗塞的地形图，并评估观察者在地形图上的一致性。

方法

我们回顾性地审查了2014年1月至2019年9月间收治于放射科的患者的影像学和临床数据库。两名放射科医生对影像学研究进行了独立评估。分析中使用了共识数据。

结果

回顾性回顾分析发现92例髓样梗死患者。受影响的血管区域是外侧（n  = 58），前内侧（n  = 28），后侧（n  = 3）和前外侧（n  = 1）。2例患者有半髓梗塞。髓样梗死的尾脑水平为上（n  = 34），中（n  = 31），下（n  = 4），中上（n  = 13）和中下（n  = 10）。延髓分为两种类型：外侧（n  = 62）和内侧（n = 28）。受影响的血管区域与延髓的脑后尾形不同（p  = 0.003）。观察发现，对于髓样梗死类型，观察者之间的一致性极好，相比之下，对于血管区域而言适中，对于后尾状位则比较合理。前外侧和后方区域最容易被误诊，而后尾额形貌差异最大的是中等水平。

结论

准确的地形学评估延髓可能是研究卒中病因的重要基础。但是，可能无法始终获得正确的地形评估，因此应仔细评估较小的区域，例如前外侧和后侧。