Evaluation Value Of Prognosis Using FLAIR Vascular Hyperintensity In Acute Middle Cerebral Artery M1 Cerebral Infarction

Research ObjectiveIn recent years,FVH(Flair vascular hyperintensity)has been gradually used to evaluate the collateral circulation of pia mater of patients with acute ischemic stroke.In this study,patients with acute middle cerebral artery M1 stenosis or occlusion cerebral infarction are investigated to study the influencing factors of FVH;analyze the value of FVH in evaluating the outcome of patients with acute ischemic stroke;and examine the relationship between FVH and acute cerebral infarction。Materials and Methods124 patients with severe M1 stenosis(rate of stenosis≥70%)caused by the atherosis of the middle cerebral artery who was hospitalized in the Second Hospital of Dalian Medical University which from November 2016 to October 2018.The pre-hospital brain CT helps exclude the hemorrhage.And the routine sequence,MRA sequence,DWI sequence and FLAIR sequence of brain magnetic resonance are completed within 3 days after hospitalization.General clinical data and past medical history of patients are collected,and the imaging factors related to FVH are analyzed.The nuclear magnetic FLAIR imaging hyperintensities are scored and grouped by applying the Alberta Stroke Program Early CT score(ASPECT).They are grouped into No-expression group(0 score),Low-expression group(1-4 scores),Middle-expression group(5-8scores)and high-expression group(9-12scores)according to the scores;they are also divided into two groups according to the body part of focus: FVH-I-ASPECT and FVH-O-ASPECT.The NIHSS scores are recorded at the beginning of the hospitalization and 1 week later.The Mann-Whiteny U test is used to analyze the difference of NIHSS scores in different FVH groups and the proportions of aggravation within 1 week.The influences exerted by FVH on disease severity and disease progression is investigated.Clinical data and mRS scores in 3months between different groups are compared.Results A total of 124 patients are included in the analysis,among which 109(87.9%)patients are associated with distal FVH.Multi-factor regression analysis shows that hypertension and long-term orally taking statins could affect FVH grading.Patients with hypertension and long-term orally taking statins have higher FVH grade.FVHs are further grouped into FVH-O-ASPECT and FVH-I-ASPECT.It is found that patients with hypertension and long-term orally taking statins have more FVH-O-ASPECT high marks.The difference is statistically significant(P<0.01).It indicates that the influence exerted by hypertension and long-term therapy of orally taking statins on FVH is mainly outside the focus.And they can also promote the formation of collateral circulation of the piamater.The NIHSS scores of different groups at the beginning of the hospitalization and the time when they are hospitalized for 1 week are analyzed and compared.It is found that the NIHSS scores of the high marks of FVH-I-ASPECT are higher.P<0.01,the difference is statistically significant.Patients who are aggravated within 1 week are included in the analysis.It is found that the higher the FVH-I-ASPECT scores are,the greater the possibility of aggravation within 1 week is(p<0.05).Multi-factor regression analysis is conducted on factors with p<0.05.The result shows that NIHSS scores are positively correlated with FVH-I-ASPECT scores at the beginning of the hospitalization and the time when the patients are hospitalized for 1 week(OR,1.35;95% CI,1.23-1.48;p=0.02).The NIHSS scores are negatively correlated with FVH-O-ASPECT scores at the beginning of the hospitalization and the time when the patients are hospitalized for 1 week(OR,0.87;95% CI,0.79-0.95;p=0.002).The history of hypertension is positively correlated with the FVH-O-ASPECT scores(OR,1.21;95% CI,1.7-1.32;p=0.01).Long-term therapy of orally taking statins are positively correlated with the FVH-O-ASPECT scores(OR,1.33;95% CI,1.20-1.41;p=0.03).Single-factor analysis shows that the higher the FVH-O-ASPECT score is,the better the prognosis is,the difference is statistically significant(5.0VS2.0,P = 0).The higher the FVH-I-ASPECT score is,the worse the prognosis is,the difference is statistically significant,(4.0VS2.0,P=0.001).Multi-factor Logistic regression analysis finds that FVH-I-ASPECT score is negatively correlated with prognosis(OR,2.03;95%CI,1.35-3.19,P=0.002),and FVH-O-ASPECT score is positively correlated with prognosis(OR,0.43;95% CI,0.32-0.59,P=0).Conclusions 1.FVH has a higher positive rate in patients with severe M1 stenosis or occlusion of the middle cerebral artery.2.Hypertension and long-term orally taking statins can influence the scores and locations of FVH.3.The influence exerted by FVH on the disease severity and the progression is related to the location of FVH.4.The prognosis of patients with severe M1 stenosis or occlusion of the middle cerebral artery is related to the location and number of FVH.The FVH-O-ASPECT score is positively correlated to the prognosis,while the FVH-I-ASPECT score is negatively correlated to the prognosis.