Related Factors And Clinical Significances Of FLAIR Vascular Hyperintensities In Acute Ischemic Stroke

Objective:To explore the influencing factors and clinical significances of vascular hyperintensities in fluid-attenuated inversion recovery sequence in patients with acute ischemic stroke in the unilateral middle cerebral artery blood supply area,and further evaluate the relationship between FVH and the prognosis,collateral circulation of patients.Materials and Methods:76 patients who were presented with unilateral MCA areas acute stroke from December 2018 to May 2019 were collected in our study.54patients underwent 90-day mRS follow-up;57 patients'MR imaging sequences included T1WI,T2WI,DWI,FLAIR and MRA;33 patients underwent mCTA examination;14 patients had the complete MR imaging sequences while received mCTA examination.The equipment used Siemens 3.0T magnetic resonance scanner and General Electric Company(GE)Gems Spectrum CT(Discovery CT 750 HD).Two observers performed FVH scores and mCTA scores on the FLAIR sequence and the multi-phase CTA-MIP map according to the scoring criteria,respectively.These patients were divided into FVH positive group(FVH-ASPECT?1)and FVH negative group(FVH-ASPECT=0)according to the FVH scores.To investigate the influencing factors of FVH and its clinical significances.According to the 90d mRS scores,54 patients were divided into good prognosis group(mRS?2)and poor prognosis group(mRS>2).To investigate the related factors affecting the prognosis of patients.Intraclass correlation coefficient(ICC)was used to assess the consistency of FVH scores and mCTA scores between the two observers.Further evaluate the correlation relationship between FVH scores and mCTA scores.Results:Univariate analysis showed statistically significant differences in hypertension,admission NIHSS scores,infarction volume,degree of vascular stenosis and 90d mRS scores between the FVH positive group and FVH negative group(p<0.1).Compared with FVH-negative patients,FVH-positive patients had lower incidence of hypertension,large infarction volume and intracranial vascular severe stenosis,and the admission NIHSS scores,90d mRS scores were higher.In the binary logistic regression model,only the grades of vascular stenosis was significantly correlated with FVH(OR=0.222;95%CI 0.099-0.500;p<0.001)and The higher FVH scores,the more severe of vascular stenosis(r=0.635,p=0.000).Univariate analysis showed statistically significant differences in patients'gender,admission NIHSS scores,infarction volume,and FVH scores between the good prognosis group and the poor prognosis group(p<0.1).Compared with the poor prognosis group,the good prognosis group had lower admission NIHSS scores(5.21±3.85 vs.9.90±4.06;p=0.000)and FVH scores(1.26±1.45 vs.2.24±1.70;p=0.065),the infarction volume was smaller(14.37±23.95 vs.61.28±49.14cm~3;p=0.000).In the binary logistic regression analysis showed that only small infarction volume was associated with a good prognosis(OR=0.965,95%CI 0.942-0.988;p=0.004)and the area under the ROC curve was 0.837.The two observers had good consistency in FVH scores and mCTA scores,the intraclass correlation coefficient values were 0.806,0.983(p<0.001).Spearman correlation analysis results showed that the FVH scores were negatively correlated with the mCTA scores(r=-0.553,p=0.040),and the correlation was statistically significant.Conclusions:FVH is an indirect imaging indicator of intracranial vascular severe stenosis-occlusion in AIS patients and it can evaluate patients'clinical condition.FVH positive indicates that the patients have large infarction volume and severe neurological damage.FVH positive can not predict the clinical prognosis of AIS patients at 90 days,and infarction volume is a key factor affecting its prognosis.But FVH scores are negatively correlated with mCTA scores,indicating that FVH represents poor collateral circulation.