The Value Of MRA-DWI Mismatch In Predicting Ischemic Penumbra In Acute Posterior Circulation Cerebral Infarction

Objective:The purpose of this study is to investigate the value of MRA-DWI mismatch in predicting ischemic penumbra in acute posterior circulation cerebral infarction.Methods:Retrospective analysis system in September 2015 to July 2018 in the fourth hospital affiliated to China medical university neurology hospital within 24 hours of the MRI suggest acute posterior circulation cerebral infarction and MRA 58 patients with basilar artery occlusion,DWI-ASPECTS of seven or more patients can divided into MDM-P group(MRA,DWI mismatch can positive),otherwise the MDM-N group(MRA,DWI mismatch can negative).General data,NIHSS score on admission,early deterioration of neurological function(END,increased NIHSS score 4 after 72 hours)and modified Rankin score at 3 months were compared between the two groups.Measurement data were ttested,counting data were tested withx~2 test,rank data were tested with mann-whitney rank sum test,and binary Logistic regression analysis was performed to furtheranalyze the impact of MRA-DWI mismatch on END correction,P<0.05 indicating that the analysis results were statistically significant.Results:1.Risk factor distribution of the patients:among the 58 patients,38 patients in MDM-P group and 20 patients in MDM-N group.Comparison of general clinical data between the two groups:comparison of age,gender,smoking,hypertension,diabetes,hypercholesterolemia,atrial fibrillation,coronary heart disease,and previous cerebrovascular disease between the two groups showed no statistical significance(table1).2.Early neurological deterioration(END)occurred in 18 cases(31%)in MDM-P group,and END3 cases(5.2%)in MDM-N group,P=0.015<0.05,with statistically significant difference.The median number of admission NIHSS was 3 in the MDM-P group,11.5 in the MDM-N group,P=0.011<0.05,8 in the MDM-P group,and 4 in the MDM-N group,P<0.05,indicating statistically significant differences.There were 20 cases(52.6%)with good prognosis in the MDM-P group and 8 cases(40.0%)in the MDM-N group at 3months,and the difference was not statistically significant(figure 2).There was no statistically significant difference in the distribution of treatment methods between the two groups(table 2).3.Binary classification Logistic regression analysis,found the MDM-P(OR=4.914,95%,1.158 20.860,P=0.031)was basilar artery occlusion is an independent predictor of early neurologic deterioration,in not receiving intravenous thrombolysis OR endovascular treatment in patients with this kind of influence is more obvious(OR=11.138,95%,1.371 90.505,P=0.024),the results adjusted for confounding factors such as age,time of onset to treatment(table 3).Conclusion:1.MRA-DWI mismatch can predict early deterioration of neurological function(END)in acute posterior circulation cerebral infarction within 24 hours after onset,suggesting that such patients may have ischemic penumbra,providing a basis for the selection of reperfusion therapy patients.2.MRA-DWI mismatch showed no significant difference in prognosis after 3 months.