High-resolution Magnetic Resonance Imaging Study On Classification And Prognosis Of Acute Ischemic Stroke

Objectives:1.In this study,3.0T HRMRI(High-resolution magnetic resonance imaging,HRMRI)was performed in patients with acute ischemic stroke with CISS classification(Chinese Ischemic Stroke Subtype),compared with conventional MRI sequences,discuss the application value of HRMRI in stroke classification.2.Analysis of influencing factors of endpoint events(Recent stroke deterioration and ischemicstroke recurrence in 1 year)in patients with acute ischemic stroke,investigate the prognostic value of HRMRI in ischemic stroke.Methods:Continuity to enrollment the acute ischemic stroke Patients from the Neurology Department of the First Affiliated Hospital of Nan Hua University between April,2015 and December,2016.All patients underwent routine magnetic resonance imaging(DWI,Flair,T1,T2,3D-TOF-MRA)and HRMRI(3D-T1-VISTA,T2 WI,SWI)sequence examination within 3 days of admission.Combined with the clinical information(such as Personal history,anamnesis,biochemical examination and ECG,echocardiography,TCD,carotid ultrasound and other auxiliary examination),Patients were divided into different CISS(Chinese ischemic stroke subtypes).comparing the difference of CISS type between conventional MRI and HRMRI.All patients were followed-up at thetime of 3 months and 1 year after discharge,Observe the incidence of end point event,compare the difference of end points of stroke subtypes.The common risk factors for ischemic stroke of single factor and multi factor analysis(such as hypertension,diabetes,coronary heart disease,hyperlipidemia,smoking,intracranial artery stenosis)and the characteristics of HRMRI(plaque vulnerability)relationship with end point events.Result:1.A total of 115 patients were included in the study,including 81 male and 34 female,with a mean age of 61 years.The HRMRI showed that there was no significant abnormality in the intracranial vascular wall in 30% patients(35 cases).11% of the patients showed thickening of the wall(12 cases).and atherosclerotic plaques were found in 59% of the patients(68 cases).2.Conventional MRI and HRMRI group classificationof stroke consistent diagnosis in 99 cases(86%),and in 16 cases(14%)was inconsistent.Among which 11 cases were divided into Penetrating artery disease(PAD)by conventional MRI,while divided into large-artery atherosclerosis(LAA)by HRMRI for detecting atherosclerotic plaque from the parent artery.5 cases of suspected large atherosclerotic lesions,Conventional MRI were not find evidence of atherosclerosis hardening of the arteries were classified as undetermined type,HRMRI showed atherosclerotic plaque with mild luminal stenosis of culprit artery should be classified as large artery atherosclerosis.3.115 patients were followed up,and there were 6 cases lost follow up(5.2%).The end-point events occurred in 26 patients(23.5%),there were 15 cases of stroke deterioration(died in 10 cases),and recurrent stroke within 1 year in 11 cases(9.6%).With HRMRI classification standard,the undetermined etiology type end-point event rate is highest,the incidence rate of perforating artery type end-point is lowest,the difference was statistically significant(P<0.05).4.Single factors and Muti factors showed that age(OR= 3.670;95%CI:1.196~11.261),admission NHISS(OR=3.054;95%CI:1.008~ 9.257),hypertension(OR= 3.318;95%CI:1.010~10.902),intracranial artery atherosclerotic vulnerable plaques(OR=6.181;95%CI:1.452~26.314)were ischemic stroke risk factors for end-point event.Conclusion:1.HRMRI is more sensitive to the diagnosis of intracranial atherosclerotic disease,and is help for diagnosis of stroke classification.2.Evaluation of plaque stability in HRMRI may help to evaluate the prognosis of ischemic stroke.