Application Study Of Hyperintense Vessel Sign Combined With DWI In The Evaluation Of Acute Ischemic Stroke

Objective To explore the application value of hyperintense vessel sign(HVS)on the magnetic resonance fluid-attenuated inversion recovery(FLAIR)combined with diffusion weighted imaging(DWI)in the diagnosis of acute ischemic stroke(AIS)brain tissue lesions.Methods The imaging and clinical data of 139 patients with AIS in the blood supply area of the middle cerebral artery(MCA)were collected.Patients with different onset time periods(<6h,6-24 h,>24h)were divided into HVS positive group and HVS negative group according to the presence or absence of HVS.The relative ADC value(r ADC(center))was measured,which was the center of the infarcted focus in each group compared with the normal area on the opposite side.The degree of stenosis of the middle cerebral artery on MRA was scored quantitatively,the NIHSS scores of each group of cases were collected at the same time,and compared the difference of the r ADC(center),MRA scores and NIHSS scores between the HVS positive group and HVS negative group in each onset period.Meanwhile,combined the actual condition of the patients,58 patients of 139 cases were undergone head and neck CTA examinations concurrently.According to the presence or absence of distal HVS,they were divided into distal HVS positive group and distal HVS negative group.The status of the medial cranial branch of the patients in the group was scored by r LMC,the differences in r LMC scores between the distal HVS positive group and the distal HVS negative group were compared.41 patients of 139 cases were undergone CT perfusion(CTP)scan simultaneously.According to whether the ASPECT scores of HVS and DWI match,they were divided into HVS/DWI match and HVS/DWI mismatch.Compared the differences between HVS/DWI mismatch and CTP in the judgment of condition in ischemic penumbra(IP).the mismatch rate of the lesion site in the CTP examination(V ischemic hypoperfusion area/V infarcted core area)was calculated,performed the ASPECT score on the HVS/DWI mismatch,and compared the HVS/DWI mismatch high group(≧2points)and The HVS/DWI mismatch low group(<2 points)corresponds to the difference in the mismatch rate of the lesion area examined by CTP.Results When the onset time was less than 6h,the difference in r ADC(center)between the HVS positive group and the HVS negative group was statistically significant(P<0.05).When the onset time was longer than 6h,the difference in r ADC(center)between the two groups of data was not statistically significant(P>0.05).When the onset time was less than 24 h,the difference in NIHSS score between HVS positive group and HVS negative group was statistically significant(P<0.05).When it was longer than 24 h,there was no significant difference in NIHSS score between the two groups.At any onset time(<6h,6-24 h,>24h),the MRA stenosis score between the HVS positive group and HVS negative group had statistical difference(P<0.05).The r LMC score based on head and neck CTA was statistically different between the distal HVS positive group and the distal HVS negative group(P<0.05).Compared with CTP,HVS/DWI mismatch had no statistically significant difference in the existence of IP(P>0.05).The sensitivity of HVS/DWI mismatch in judging IP was 77.7%,specificity was 71.4%,and Kappa value was 0.476.There was a statistical difference in the mismatch rate of CTP between the high group of HVS/DWI mismatch and the low group of HVS/DWI mismatch(P<0.05).Conclusion(1)HVS can provide help in assessing the patient’s condition,and it can determine the severe stenosis or occlusion of the cerebral blood artery within a long time period of onset.(2)The distal HVS indicates that a better collateral circulation has been established in the lesion area.(3)HVS/DWI mismatch and cranial CTP have good consistency in judging the presence of ischemic penumbra.HVS combined with DWI can help quickly evaluate the blood perfusion status of brain tissue.