Study On The Correlation Between MRI Perfusion Imaging And The Prognosis Of Stroke With Wind-phlegm Blocking Collaterals

Objective: To explore the prognostic value of 3.0T weighted imaging(PWI)and its imaging features in patients with acute ischemic stroke with wind-phlegm blocking collaterals.Methods: A total of 41 cases of acute ischemic stroke were collected from the hospital of traditional Chinese medicine affiliated to southwest medical university from October 2018 to October 2019.All the 41 patients with cerebral apoplexy were divided into wind-phlegm and collateral-blocking syndrome based on TCM syndrome differentiation.All the 41 patients were diagnosed as acute ischemic cerebral apoplexy with wind-phlegm blocking collaterals,and lost the opportunity for thrombolysis or interventional surgery.All the patients were treated with integrated traditional Chinese and western medicine and followed up.All patients received routine MRI sequences of 3.0T before treatment,including T1 WI,T2WI,FLAIR,DWI and PWI,and all patients were given NIHSS score upon admission.According to the NIHSS score,patients with acute ischemic stroke were classified as mild,moderate and severe.Prognostic evaluation was made according to the modified Rankin score of 90d:(1)good: 0-2 points;(2)Bad ending: 3-6 points.The location,distribution and number of infarcts of all patients with cerebral infarction were recorded.The values of MTT,CBF and CBV were measured on the original perfusion image.ADC value and volume of infarct lesions were measured.Patients were recorded with FLAIR sequence hyperintensity and presence of ischemic penumbra.The above measured data were statistically analyzed using SPSS 23.0 software.Results:(1)A total of 41 patients with wind-phlegm blocking collateral-type acute ischemic stroke were included in this study,including 26 males and 15 females.The average age was 62.68±8.81 years.According to the NIHSS score,20 patients(48.78%)were mild,16(39.02%)were moderate,and 5(12.20%)were severe.According to the improved mRS score on 90 d,the prognosis was good in 32 cases(78.05%)and poor in 9 cases(21.95%).The distribution of infarction sites: 15 cases(36.59%)of paraventricular infarction,16 cases(39.02%)of cerebral lobes,16 cases(39.02%)of basal ganglia region,3 cases(7.31%)of cerebellar hemisphere.Multiple cases occurred in 33 patients(80.49%)and single cases in 8 patients(19.51%).The infarct volume of 41 patients was(19.52±11.43)cm3.rMTT :(17.19±6.40)s;rCBV :(1.67±0.86)ml/g;rCBF :(5.97±2.78)ml/(g*min);ADC :(0.49±0.13)×10-3mm2/s;There were 4 cases(9.76%)with ischemic penumbra and 37 cases(90.24%)without ischemic penumbra.Nine cases(21.95%)of FVH were positive and 32 cases(78.05%)were negative.(2)The differences between rCBF(F=4.94,P < 0.05),ADC value(F=5.91,P < 0.05),and lesion volume(F=8.87,P < 0.05)in PWI parameter values were statistically significant.There was no significant difference between rCBV(F=0.86,P > 0.05),rMTT(F=1.28,P > 0.05)and the degree of illness.The degree of the patient's illness was negatively correlated with rCBF(rs=-0.56,P < 0.05)and ADC values(rs=-0.42,P < 0.05).In other words,the smaller the rCBF and ADC values were,the more severe the patient's illness was.There was a positive correlation with the volume of infarction lesion(rs=0.69,P < 0.05),the larger the lesion size,the more severe the patient's condition.(3)When the rCBF threshold was 5.9 ml/(g*min),the sensitivity and specificity of predicting good prognosis of stroke were 73.3% and 87.5%,respectively.The area under curve(AUC)was 0.81,P < 0.05.When the ADC boundary value was 0.42×10-3mm2/s,the sensitivity and specificity of predicting good prognosis of stroke were 74.3% and75.0%,and the AUC of the area under the curve was 0.79,P < 0.05.(4)Infarction lesions rCBF(rs = 0.51,P < 0.05),the ADC values(rs = 0.48,P < 0.05),ischemia half dark belt(rs = 0.61,P < 0.05),a positive FVH signs(rs = 0.45,P < 0.05)and prognosis were positively correlated,rCBF value is,the larger the ADC values,when patients exist ischemia half dark belt,FVH signs are positive,the greater the likelihood of its prognostic outcomes as well.However,the volume(rs=-0.65,P < 0.05)was negatively correlated with the prognosis,that is,the larger the infarct volume,the less likely it was to have a good prognosis.Conclusion: 1.MRI routine examination and PWI examination are of high diagnostic value for patients with acute cerebral apoplexy,which can provide important clinical information such as the range,size and location of infarction,as well as signs of ischemic penumbra and FVH,providing reliable basis for clinicians to accurately judge the condition.2.The degree of AIS was correlated with rCBF value,ADC value and lesion volume.Among them,the rCBF and ADC values were negatively correlated with the degree of the disease,that is,the smaller the rCBF and ADC values were,the more severe the disease degree of the patient was.There was a positive correlation with the volume of infarction lesion,that is,the larger the lesion size,the more severe the patient's condition.3.The rCBF value,ADC value,ischemic penumbra,FVH sign and lesion size of the infarcted lesion were the factors affecting the prognosis of the patient.The higher the rCBF value,the higher the ADC value,the presence of ischemic penumbra,and the positive FVH signs,the greater the possibility of a good prognosis.However,there was a negative correlation between volume and prognosis,that is,the larger the infarct volume,the lower the probability of good outcome.