| Objective: To evaluate clinical diagnostic value of susceptibility weighted imaging in arterial thrombosis of acute ischemic stroke by contrast with 3D-TOF MRA.Further analyze the relationship between susceptibility vessel sign and short-term prognosis of acute ischemic stroke patiens who hadn't received reperfusion therapy.Methods: One hundred and twelve patients with acute ischemic stroke who met the inclusion criteria were collected in this study.All patiens underwent MR examination,including T1WI?T2WI?DWI?3D-TOF MRA and SWI.To compare the consistency and difference of SWI and 3D-TOF MRA in the detection of arterial thrombosis in AIS patients,including the overall detection of thrombosis and the detection of different stages(within 3 days,3-14 days)and different sites(anterior cerebral artery,middle cerebral artery and posterior cerebral artery).According to the time from onset to MR examination,the patients were divided into two groups: within 3days and 3 to 14 days.To compare the difference in the detection rates of thrombus at different periods with SWI.Clinical and imaging information of 112 patients were recorded.According to whether susceptibility vessel sign was shown on SWI,the patients were divided into SVS positive group and SVS negative group,and analyzed the clinical data of the two groups by statistics.Modified Rankin Score(m RS)was evaluated at 3 months from symptom onset,which was used as an evaluation index for the short-term prognosis of AIS patients.MRS?2 means favorable outcome,and m RS >2 means adverse outcome.The univariate analyses and multivariate logistic regressionanalyses were performed to establish independent risk factors for the short-term outcome of patients with acute ischemic stroke,in order to research whether the presence of susceptibility vessel sign was an independent predictor of adverse prognosis at 3 months after stroke.All data were statistically processed with SPSS 25.0 software.Results:1.In all 112 patients,MRA showed responsible artery stenosis or occlusion in 48 cases,and 41 cases showed susceptibility vessel sign on SWI.There was good consistency between SVS on SWI and Intracranial arterial thrombosis on 3D TOF MRA(Kappa value=0.684),and no statisticaliy difference in the overall detection rate(P>0.05).For different stages(within 3 days,3-14 days)and different sites(anterior cerebral artery,middle cerebral artery and posterior cerebral artery)of arterial thrombosis,the two methods also showed good consistency,and there was no significant differences(P>0.05).However,the positive detection rate of arterial thrombosis within 3 days by SWI was higher than that in 3-14 days,there had statistically difference(Chi square value=27.442,P<0.001).5 cases were positive for SVS,while no corresponding stenosis or occlusion was found in MRA,all of which occurred in the M2/M3 segment of the middle cerebral artery.This indicate that SWI has advantage in displaying distal arterial thrombosis.2.Compared with the negative SVS group(71 cases),patients in the positive SVS group(41 cases)had larger infarction lesion volumes on DWI[15.94(11.17,24.52)ml versus 9.45(6.12,16.38)ml],higher NIHSS scores on admission [8(5.5,13)versus 4(3,7)],and a lower proportion of patients with good prognosis[15(36.59%)versus 58(81.69%)],showing significant differences(P<0.001).The positive SVS rate of cardioembolism[8/14(57.14%)] was higher than rate of other stroke subtypes [33/98(33.67%)],but there was no statistically significant difference(P>0.05).3.The prognosis was poor in 39 patients and good in 73 patients.Patients with a poor prognosis not only had a higher proportion of atrial fibrillation[10(25.64%)versus6(8.22%)],larger infarction lesion volumes on DWI [20.11(12.29,30.39)ml versus9.27(5.38,14.57)ml] and higher NIHSS scores on admission[11(8,15)versus 4(3,5.5)],but also a higher positive rate of SVS[26(66.67%)versus 15(20.55%)].Tthere were significant differences between two groups(P<0.05).The results of multivariate logistic regression analyses revealed that NIHSS scores on admission(OR:1.426,95%CI:1.220-1.667,P<0.001)and the presence of SVS(OR:3.611,95%CI:1.135-11.493,P<0.05)were independent factors to predict poor short-term prognosis in acute ischemic stroke patients who untreated by reperfusion.Conclusions:1.SWI has a high clinical value in displaying responsible arterial thrombosis in acute ischemic stroke,which shows good consistency results with MRA,and can also detect the distal arterial thrombosis well.2.Susceptibility vessel sign patients show large DWI lesion volumes,high NIHSS scores on admission,severe neurological deficits and poor short-term outcomes.Detecting the thrombus with SWI can provide more effective information for clinical to evaluate patient's condition and to select appropriate treatment.3.Susceptibility vessel sign is an independent factor to predict poor recent prognosis for patients with acute ischemic stroke who have not received reperfusion therapy,which is helpful for clinical evaluation of outcome. |
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