Analysis Of The Diagnostic Value Of FLAIR Hyperintense Vessel Sign For Acute Ischemic Stroke And Construction Of A Prognostic Prediction Model

Part Ⅰ.Analysis of the diagnostic value of FLAIR hyperintense vessel sign for acute ischemic strokePurpose:To explore the feasibility and accuracy of FLAIR Hyperintense vessel sign(HVS)in evaluating the formation of ischemic penumbra and collateral circulation in patients with Acute ischemic stroke(AIS),and to study whether HVS can bring convenience to the early diagnosis of AIS in clinic.Materials and Methods:This study is a retrospective analysis.From January 2019 to March 2022,200 patients with acute ischemic stroke were collected in the Second Affiliated Hospital of Guangzhou Medical University.After screening,there were 54 patients who met the inclusion criteria,including 43 males and 11 females,with an average age of 64.42 ± 9.79 years.There were 32 cases in HVS positive group and 22 cases in negative group.The collateral circulation of CT angiography(CTA)in two groups of patients was evaluated by regional leptomeningeal collateral score(rLMC).The data of each group(mean transit time,MTT),time to peak,TTP),cerebral blood volume(cerebral blood volume)were measured by computed tomography perfusion imaging(CTP)in ischemic penumbra of two groups of patients.CBV),cerebral blood flow,CBF)).At the same time,the scores of National Institute of Health Stroke Scale(NIHSS),modified Rankin Scale(mRS)at admission,age,sex,hypertension,diabetes,smoking history,total cholesterol and triglyceride of patients in both groups were recorded.The data of two groups of patients were statistically analyzed.Results:1.Comparing the general data of the two groups of patients,the results showed that there was no significant difference in gender,age,smoking history,diabetes,hypertension,triglyceride,total cholesterol and NIHSS score at admission between the two groups(P>0.05),but there was significant difference in mRS score at admission(P<0.05).2.There was a statistical difference in CTA collateral circulation rLMC score between the two groups(P<0.01),and the collateral circulation score of HVS positive group was better.3.The ratio of CTP measurement results(rMTT,rTTP,rCBF,rCBV)of ischemic penumbra between the two groups was statistically different(P<0.01).According to the CTP results,the imaging staging of ischemic penumbra between the two groups was statistically different(P<0.01),and the ischemic penumbra in HVS positive group was better.Conclusion:FLAIR hyperintense vessel sign is an important imaging sign to reflect ischemic penumbra and collateral circulation in AIS patients during unconditional enhanced examination in emergency,which is helpful to realize early clinical diagnosis and early intervention treatment,and improve the treatment effect of patients.Part Ⅱ.Analysis of prognosis prediction model of acute ischemic stroke Purpose:Based on non-enhanced imaging examination,a statistical prediction model of AIS patients’ prognosis was established,and the influence of HVS on AIS patients’ prognosis was discussed,in order to provide a reliable auxiliary prediction tool for clinicians and avoid the adverse outcome of acute ischemic stroke.Materials and Methods:Retrospective collection of 120 patients diagnosed as acute ischemic stroke and admitted to the hospital from January 2019 to March 2022 in the Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine.The clinical baseline data and imaging features of patients were recorded.Clinical baseline data include sex,age,hypertension,diabetes,smoking history,total cholesterol and triglyceride.Imaging features include artery dense sign,island band sign,unclear demarcation between skin and medulla,disappearance of sulcus,peripheral brain edema on plain CT scan,and whether MRA has stenosis or occlusion and HVS signs.Logistic regression analysis was used to analyze the correlation between the predictive factors in clinical baseline data and imaging data and the predicted 90-day mRS score,and a clinical baseline data and imaging sign model was established.Results:1.Total cholesterol(OR 2.692[1.442-5.026],P<0.01),whether the MRA middle cerebral artery is narrowed or occluded(OR 0.116[0.025-0.546],P<0.01),and unclear demarcation between skin and medulla(or 29.496[1.441)P<0.05),sulcus disappearance(OR 0.007[0-0.345],P<0.05)and peripheral brain edema(OR 15.664[1.832-133.944],P<0.05)can be used as independent predictors of 90-day mRS score.Age(OR 0.928[0.855-1.008],P>0.05),sex(OR 3.313[0.911-12.045],P>0.05),hypertension(OR 0.376[0.074-1.908],P>0.05),diabetes mellitus(OR 1.23[0.231-6.553],P>0.05),smoking history(OR 0.27[0.049-1.477],P>0.05),triglyceride(OR 1.985[0.827-4.77]P>0.05),arterial dense sign(OR 3.462[0.238-50.399],P>0.05),island band sign(OR 0.031[0.001-1.548],P>0.05),HVS(OR 1.155[0.324]2.The ROC curve was used to study the relationship between 90-day mRS score and various prognostic factors.The results showed that the Area under the curve(AUC)was 0.912,the sensitivity was 0.88,and the specificity was 0.79,so the model was effective.The Positive Predictive Value(PPV)is 0.81,and the Negative Predictive Value(NPV)is 0.87.Conclusion:Based on non-enhanced CT and MRI examination,the multivariate Logistic regression model is constructed by incorporating the clinical baseline data and imaging data of patients,which has a good predictive effect on the prognosis of AIS patients.Although HVS can’t be used as a predictor of prognosis,the construction of this model is helpful to identify patients with poor prognosis as early as possible,and then to assist clinical intervention in the early stage of onset.