Preliminary Study On Asymmetric Venins Sign Evaluation Prognosis Of Basal Ganglia And Middle Cerebral Artery Infarction

Part 1 Asymmetry deep medullary veins at susceptibility weighted imaging is a biomarker for poor prognosis in basal ganglia acute infarctionObjective: The isolated basal ganglia(BG)infarction is relative uncommon type in the stroke of anterior circulation.The imaging prognostic evaluation of BG infarction has not well been studied.The aim of our study was to explore the diagnostic impact of asymmetry deep medullary veins(DMV)at susceptibility weighted imaging(SWI)in isolated basal ganglia acute ischemic stroke(AIS).Methods:The conventional MRI findings and clinical data of 67 patients with isolated acute BG infarction were included,and routine MRI,DWI,MRA,and SWI examinations were completed within 72 hours from onset.MRI signs including the middle cerebral artery disease,initial DWI volume of the lesions,and DMV sign.The clinical data included age,gender,related risk factors,the National Institute of Health stroke scale(NIHSS)of admission and seventh day after stroke ictus.The outcome of patients was evaluated with NIHSS scoringe at seventh day after stroke ictus.The diagnostic performance of variables was evaluated with Student's t-test or Mann-Whitney U test,receiver operating characteristic(ROC)curve,as well as multivariate logistic regression analysis.Results: Among 67 patients,32 were classified as favorable group and 35 as unfavorable group according to NIHSS scores in 7th day [5.5(3,7)vs 2(1,3)(P<0.05)].Univariate analysis showed that in unfavorable outcome group,compared to favorable outcome group,there was larger lesion volume on initial DWI(2.52 ml vs 1.61 ml,P=0.009),higher incidence of prominent middle cerebral artery(MCA)disease(50% vs 19%,P=0.024),higher incidence of positive DMV(83% vs 16%,P<0.001).The multivariate analysis showed that only lesion volume on initial DWI(OR=1.46,95%CI: 1.01-2.11,P=0.045)and positivie DMV(OR=37.75,95%CI: 7.45-188.97,P<0.001)were the independent factors of unfavorable outcome of isolated BG infarction patients.Conclusions:Asymmetry DMV is biomarker for poor prognosis in BG acute infarction.Asymmetry DMV is an independent prognosis factors and can improve the diagnostic performance when adding it to multiparametric MRI in BG acute infarction evaluation.Part 2 Combined APCV and FHVcan improve the multimodality MRI prognosis efficiency in assessing the MCA acute infarctionObjective: FLAIR hyperintense vessel(FHV)sign and SWI asymmetric prominent cortical veins(APCV)sign are common imaging signs of acute cerebral infarction.FHV can be used to reflect the degree of cerebral perfusion insufficiency,and APCV can be used to evaluate the range of hypoperfusion in acute cerebral infarction.The purpose of this study was to explore the value of the combination of APCV and FHV signs in assessing the prognosis of MCA acute infarction.Methods:A retrospective analysis was performed on 43 patients with acute infarction in the MCA blood supply,and all patients completed the MR DWI,FLAIR,SWI,MRA,and PWI sequences within 72 hours.FLAIR images was used to evaluate the score of FHV,and SWI Min IP maps evaluate the APCV display.The PWI pseudo-color image was obtained after software processed.The ratio of cerebral blood flow(CBF)around the ischemic infarction area to the contralateral side CBF area of the normal brain tissue was defined as relative cerebral blood flow(r CBF).Modified Rankin Scake(m RS)at 3 months was used to assess functional outcome.The receiver operating characteristic(ROC)curve was used to compare the diagnostic efficacy of the prognostic assessment.Results: Of the 43 patients with AIS,28 with good outcomes and 15 had poor outcomes.Compared with the good outomes group,the pooroutcomes group has larger DWI lesion volume [13.30(5.20,62.30)ml vs 2.50(1.43,5.75)ml,P=0.013)],higher FHV scores [6.00(3,8)vs 2(0,3),P<0.001],higher APCV occurrence rates(93.3% vs 14.3%,P<0.001)and lower r CBF(0.535±0.243 vs 1.207±0.419,P<0.001).Spearman correlation analysis showed that FHV scores had moderately positive correlation with APCV(r=0.521,P<0.001),FHV and APCV were moderately negatively correlated with r CBF(r=-0.511,P<0.001 and r=-0.695,P<0.001),APCV classification was highly negatively correlated with r CBF(r=-0.796,P<0.001).The area under the curve(AUC)of r CBF evaluated acute cerebral infarction in MCA blood supply area was 0.938,the sensitivity,specificity and Youden index were 1.000,0.786,0.786,respectively,but APCV combined FHV,the AUC reached 0.937,which was similar to that of r CBF,and the sensitivity,specificity and Youden index were 0.933,0.837,0.790,respectively.Conclusions:In patients with MCA acute infarction,high FHV scores and positive APCV sign often indicate poor functional outcomes;combined APCV and FHV scores have similar prognostic diagnostic efficacy to PWI r CBF in acute infarction patients,in some cases,it maybe used as an alternative to PWI.