Neurological deterioration in small vessel disease may be associated with increase of infarct volume

Background and purpose: The mechanism of neurological deterioration in small vessel disease is unclear. We examined the relationship between neurological deterioration and change of infarct volume in acute small vessel disease. Methods: We studied consecutive patients with acute supratentorial small vessel disease. Patients were classified into two groups (D: group with deterioration, N: group with no deterioration). We performed serial MRI studies, measured infarct volumes using NIH Image, and calculated the changes in infarct volume (Delta volume) between initial and follow-up diffusion-weighted imaging (DWI). Results: Seventy-two patients (44 males, 68 +/- 11 years of age) were enrolled. Fifteen patients exhibited neurological deterioration (group D) and 57 patients did not (group N). Initial infarct volume was 0.66 cm(3) in group D and 0.45 cm(3) in group N (p=0.025). Infarct volumes on follow-up DWI were 1.41 cm(3) and 0.72 cm(3), respectively (p=0.001). The Delta volume in group D was larger than that in group N (0.76 cm(3) vs 0.27 cm(3), p=0.001). In order to differentiate D from N group, sensitivity specificity analysis yielded a cut-off value of Delta volume of 0.5 cm(3) for differentiation of the two groups, which exhibited a sensitivity of 80% and specificity of 84%. Multivariate logistic regression analysis demonstrated that increase in infarct volume of over 0.5 cm(3) (odds ratio; 18.0, 95% CI; 1.4 to 270, p = 0.027) was independently associated with neurological deterioration in patients with acute small vessel disease. Conclusions: Enlargement of infarct volume may contribute to neurological deterioration in acute small vessel disease. (C) 2007 Elsevier B.V. All rights reserved.