| ObjectiveAcute ischemic stroke is the most common type of stroke and is a disease with high morbidity,mortality,and disability.This study aims to explore the value of hydrogen proton magnetic resonance spectroscopy(1H-MRS)combined with diffusion tensor imaging(DTI)and neutrophil-to-lymphocyte ratio(NLR)in predicting the prognosis of patients with acute ischemic stroke,and to provide a reliable basis for the selection of clinical follow-up treatment and rehabilitation programs to improve the prognosis and quality of life of patients with acute ischemic stroke.Material and MethodsClinical and imaging data were collected from the Second Affiliated Hospital of Guangzhou Medical University from December 2021 to December 2022 from patients admitted through the emergency green channel and outpatient clinics who were considered to be diagnosed with ischemic stroke in the acute phases(within 3 days to 2 weeks of onset).A total of 38 patients were eligible,including 27 male patients and 11 female patients,with a mean age of 63.1±11.1 years.MRI scans,including cross-sectional DWI,multivoxel hydrogen proton magnetic resonance spectroscopy(1H-MRS),diffusion tensor imaging(DTI)scans,and the rest of the conventional sequence scans were completed in the radiology department within 24 hours of admission.The prognostic value of each parameter in predicting the prognosis of acute ischemic stroke was statistically analyzed,and the ROC curve was used to evaluate the prognostic value of 1H-MRS,DTI-related parameters,NLR,and the combined application of each parameter.The ROC curve was used to evaluate the efficacy of the 1H-MRS,DTI-related parameters,NLR and the combined application of each parameter for predicting the prognosis of acute ischemic stroke and the optimal threshold.Results1.The differences in gender(χ2=0.242)and age(t=-1.428)between good prognosis group and poor prognosis group were not statistically significant(P>0.05).2.NAA/Cr and Cho/Cr in the good prognosis group were 1.406±0.549 and 1.033 ±0.355,while NAA/Cr and Cho/Cr in the poor prognosis group were 1.199±0.552 and 1.442±0.410,respectively,with statistically significant differences between the two groups(P<0.01)and NAA/Cr were not statistically different(P=0.313>0.01);Lac/Cr in the good prognosis group was(0.19,0.60);0.41,Lac/Cr in the poor prognosis group was(0.34,4.76);3.42,Lac/Cr between the two groups was statistically significantly different(P<0.01).3.FA value of 0.086±0.034 in the good prognosis group and 0.059±0.009 in the poor prognosis group were statistically different between the two groups(P<0.05);RD and AD values of(0.03,0.16);0.13,(0.22,0.36);0.14 in the good prognosis group and RD and AD values of(0.23,0.18);0.16,(0.09,0.31);0.22,and the RD and AD values were not statistically different between the two groups(P>0.05).4.NLR in the good prognosis group was(2.02,3.15);1.80,and NLR in the poor prognosis group was(3.62,6.89);3.88,with a statistically significant difference between the two groups(p<0.01).5.The indicators Cho/Cr,Lac/Cr,FA value,and NLR of 1H-MRS and DTI,which are statistically significant in distinguishing good and poor prognosis,were selected to draw the Receiver Operating Characteristic(ROC),and the areas under the curves were 0.539,0.629,0.614,and 0.657,respectively;the optimal thresholds determined by the Jorden index were 1.03,0.81,0.065,and 3.99(where FA values are in units of×10-3mm2/s);the sensitivity and specificity for prognosis prediction of acute ischemic stroke were(70.0%,53.6%),(70.0%,92.9%),(71.4%,90.0%),and(80.0%,85.7%),respectively.6.The ROC curves were generated by combining Lac/Cr with FA value,Lac/Cr with NLR,FA value with NLR,and Lac/Cr with FA value with NLR to generate(PRE)respectively.The area under the curve of Lac/Cr combined with FA value and NLR was 0.946,followed by Lac combined with NLR and Lac combined with FA value,both with an area under the curve of 0.918,and finally the FA value combined with NLR curve with an AUC of 0.893.The ROC curves were analyzed for differences,and there were no statistical differences between Lac combined NLR,Lac combined FA values,Lac/Cr and FA values and NLR.Conclusions1.Multivoxel hydrogen proton magnetic resonance spectroscopy(1H-MRS)and diffusion tensor imaging(DTI)are clinically important in predicting the prognosis of patients with acute ischemic stroke.2.The optimal thresholds for Cho/Cr,Lac/Cr,FA values,and NLR to predict acute ischemic stroke patients were 1.03,0.81,0.065,and 3.99,respectively.3.The predictive prognostic efficacy of multivoxel hydrogen magnetic resonance spectroscopy(1H-MRS),diffusion tensor imaging(DTI),and neutrophil-to-lymphocyte ratio(NLR)in combination with each other is better than any single technique or index.4.NAA/Cr is not statistically significant in predicting the prognosis of patients with acute ischemic cerebral stroke. |
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