The Factors Influencing Total MRI Burden And The Correlation Between Middle Cerebral Artery Pulsatility Index And Total MRI Burden In Elderly Patients With Cerebral Small Vessel Disease

Part one The factors influencing total MRI burden in elderly patients with cerebral small vessel diseaseObjective:Retrospectively analyze the factors influencing total magnetic resonance imaging(MRI)burden in elderly patients with cerebral small vessel disease(CSVD)to provide theoretical reference for the prevention and treatment of CSVD.Methods:The inpatients aged 60 and above with CSVD from the department of neurology in our hospital were enrolled from March 2017 to December 2020.The demographic characteristics,general clinical data,biochemical parameters,transcranial doppler ultrasound(TCD)parameters and Brain MRI data were collected.TCD parameters included peak systolic velocity(PSV),pulsatility index(PI)of middle cerebral artery(MCA),etc.MRI data,including lacunar infarcts(LIs),white matter hyperintensities(WMHs),cerebral microbleeds(CMBs)and enlarged perivascular spaces(EPVSs),were collected to evaluate the total burden of CSVD.The score of total MRI burden ranged from 0 to 4 and the patients were divided into low burden group(0～1 points)and high burden group(2～4 points).SPSS 26.0 was used to analyze the factors influencing total MRI burden in elderly patients with CSVD.P<0.05 indicated that the difference was statistically significant.Results:A total of 203 elderly patients with CSVD,aged from 60 to88 years old,were included in this study,all of whom were divided into low burden group(75 cases)and high burden group(128 cases).Multivariate logistic regression analysis showed that hypertension(OR=2.569;95%CI:1.068～6.182;P=0.035),systolic blood pressure(OR=1.033;95%CI:1.006～1.061;P=0.016)and creatinine(OR=1.044;95%CI:1.009～1.079;P=0.013)were independent risk factors for total MRI burden.MCA PI(OR=1.125;95%CI:1.087～1.166;P<0.001)was significantly correlated with the increasing total MRI burden in elderly patients with CSVD.Conclusion:1.Hypertension,systolic blood pressure and creatinine were the independent risk factors for the increasing total MRI burden in elderly patients with CSVD.2.MCA PI is significantly correlated with the increasing total MRI burden in elderly patients with CSVD.Part two The correlation between middle cerebral artery pulsatility index and total MRI burden in elderly patients with cerebral small vessel diseaseObjective:To explore the correlation between MCA PI and total MRI burden in elderly patients with CSVD and to further evaluate the predictive value of MCA PI in MRI high burden and the severity of CSVD.Methods:The data collected from enrolled inpatients were the same as those in the part one.Linear regression analysis was used to explore the factors influencing MCA PI and Spearman rank correlation analysis was used to analyze the correlation between MCA PI and total MRI burden in elderly patients with CSVD.Subsequently,the receiver operating characteristic(ROC)curve was established to study the best critical value of MCA PI in predicting MRI high burden in elderly patients with CSVD.Results:1.Multivariate linear analysis showed that age(β=0.011;P<0.001),pulse pressure(β=0.004;P<0.001)、total MRI burden(β=0.074;P<0.001)was associated with MCA PI independently.2.Spearman rank correlation analysis suggested that there was strong and positive correlation between MCA PI and MRI high burden in elderly CSVD patients(r_s=0.646,P<0.001).3.The best critical value of MCA PI was1.11 and the area under the curve was 0.908(P<0.001,95%CI:0.864～0.953).The positive and negative predictive value were 92.38%and77.70%and sensitivity and specificity were 0.852 and 0.88 respectively.Conclusion:1.There is a strong and positive linear correlation between MCA PI and the increasing total MRI burden in elderly patients with CSVD.2.The MCA PI posseses a high predictive value for MRI high burden.When MCA PI is above the critical value,elderly patients had a high probability of suffering from severe CSVD.