Background and Purpose:The aim of this study was to assess the rate of chronic covert brain infarctions (CBIs) in patients with acute ischemic stroke (AIS) and to describe their phenotypes and diagnostic value.Methods:This is a single-center cohort study including 1546 consecutive patients with first-ever AIS on magnetic resonance imaging imaging from January 2015 to December 2017. The main study outcomes were CBI phenotypes, their relative frequencies, location, and association with vascular risk factors.Results:Any CBI was present in 574/1546 (37% [95% CI, 35%–40%]) of patients with a total of 950 CBI lesions. The most frequent locations of CBI were cerebellar in 295/950 (31%), subcortical supratentorial in 292/950 (31%), and cortical in 213/950 (24%). CBI phenotypes included lacunes (49%), combined gray and white matter lesions (30%), gray matter lesions (13%), and large subcortical infarcts (7%). Vascular risk profile and white matter hyperintensities severity (19% if no white matter hyperintensity, 63% in severe white matter hyperintensity, P<0.001) were associated with presence of any CBI. Atrial fibrillation was associated with cortical lesions (adjusted odds ratio, 2.032 [95% CI, 1.041–3.967]). Median National Institutes of Health Stroke Scale scores on admission were higher in patients with an embolic CBI phenotype (median National Institutes of Health Stroke Scale, 5 [2–10], P=0.025).Conclusions:CBIs were present in more than a third of patients with first AIS. Their location and phenotypes as determined by MRI were different from previous studies using computed tomography imaging. Among patients suffering from AIS, those with additional CBI represent a vascular high-risk subgroup and the association of different phenotypes of CBIs with differing risk factor profiles potentially points toward discriminative AIS etiologies.

中文翻译：

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首次缺血性卒中患者慢性隐匿性脑梗死的表型：一项队列研究

背景和目的：本研究的目的是评估急性缺血性卒中（AIS）患者慢性隐匿性脑梗死（CBI）的发生率，并描述其表型和诊断价值。方法：这是一项单中心队列研究包括从 2015 年 1 月到 2017 年 12 月连续 1546 例首次 AIS 患者的磁共振成像。主要研究结果是 CBI 表型、它们的相对频率、位置以及与血管危险因素的关联。结果：任何 CBI 存在于 574 /1546 (37% [95% CI, 35%–40%]) 的患者共有 950 个 CBI 病灶。CBI 最常见的位置是小脑 295/950 (31%)、皮质下幕上 292/950 (31%) 和皮质 213/950 (24%)。CBI 表型包括腔隙 (49%)、灰质和白质联合病变 (30%)、灰质病变（13%）和大面积皮层下梗死（7%）。血管风险概况和白质高信号严重程度（如果没有白质高信号，则为 19%，严重白质高信号为 63%，P <0.001) 与任何 CBI 的存在相关。心房颤动与皮质病变相关（调整优势比，2.032 [95% CI，1.041–3.967]）。具有栓塞性 CBI 表型的患者入院时的中位美国国立卫生研究院卒中量表评分较高（美国国立卫生研究院卒中量表中位数，5 [2-10]，P = 0.025）。结论：超过三分之一的患者存在 CBI首次 AIS 患者。由 MRI 确定的它们的位置和表型与以前使用计算机断层扫描成像的研究不同。在患有 AIS 的患者中，具有额外 CBI 的患者代表了一个血管高风险亚组，并且 CBI 的不同表型与不同的风险因素谱相关联可能指向有区别的 AIS 病因。