| ObjectiveThe correlation between FVH and 3D-ASL was investigated in patients with cerebral ischemic stroke.The correlation between the occurrence rate of FVH/DWI mismatch、the positive rate of FVH and the index of collateral circulation(ATA)was investigated.The correlation between FLAIR vascular hyperintensity(FVH-ASPECT score)and the part of ATA(ATA-ASPECT score)was explored.Whether FVH as the clinical indicators to judge a patient’s perfusion disorders and the index of collateral circulation(ATA)was assessed.Materials and methodsThe clinical and imaging data of 97 patients with stroke from April 2018 to July2020 who underwent 3D ASL(PLD=1.5s)and MRI plain scan were collected.According to the inclusion criteria and exclusion criteria,eligible patients were selected to be included in the study,including 35 patients in acute cerebral ischemic stroke(The time from the onset of symptoms to the use of MRI < 3 days)and 62 patients in subacute cerebral ischemic stroke(3 days ≤the time from the onset of symptoms to the use of MRI < 14 days).1.Clinical data were obtained and compared among patients with different grades of FVH,and calculated the sensitivity and specificity of FVHs diagnosis of vascular severe stenosis and occlusion.2.The correlation between the positive rate of FVH、the occurrence rate of FVH/DWI mismatch and the index of collateral circulation(ATA)was compared in different periods.3.The correlation between FVH-aspect score and ATA-aspect score was compared in different periods.4.Receiver operator characteristic curve was applied to evaluate whether FVH as the clinical indicators to judge a patient’s perfusion disorders and the index of collateral circulation(ATA).Results1.Among the 35 patients with acute cerebral ischemic stroke,17 cases(48.6%)were in the FVH(-)group and 18 cases(51.4%)were in the FVH(+)group.Among62 patients with subacute cerebral ischemic stroke,27 patients(43.5%)were in the FVH(-)group and 35 patients(56.5%)were in the FVH(+)group.In both acute and subacute cerebral ischemic stroke patients,the presence or absence of FVH was significantly different in the degree of vascular stenosis and the volume of infarction(P < 0.01).2.In different stages(acute stage、subacute stage and the whole stage),the positive rate of FVH was moderately correlated with the positive rate of ATA in ASL(total cerebral ischemic stroke: r=0.500,P < 0.01)、(acute cerebral ischemic stroke:r=0.510,P < 0.01)、(subacute cerebral ischemic stroke: r=0.500,P < 0.01).In different stages(acute stage,subacute stage and the whole stage),the occurrence rate of FVH/DWI mismatch was strongly correlated with the positive rate of ATA(total cerebral ischemic stroke: r=0.690,P < 0.01)、(acute cerebral ischemic stroke: r=0.690,P < 0.01)、(subacute cerebral ischemic stroke: r=0.700,P < 0.01).3.In both acute and subacute ischemic stroke patients,FVH-ASPECT and ATAASPECT scores had a good consistency.(total cerebral ischemic stroke: r=0.800,P< 0.01)、(subacute cerebral ischemic stroke: r=0.813,P < 0.01)、(acute cerebral ischemic stroke: r=0.783,P < 0.01).4.In patients with acute cerebral ischemic stroke,FVHs detected ATA positive with a sensitivity of 84.6% and a specificity of 68.2%(AUC=0.687;95%CI,0.505-0.869;P < 0.01);In patients with subacute cerebral ischemic stroke,FVHs detected ATA positive with a sensitivity of 79.2% and a specificity of 78.9%(AUC=0.857;95%CI,0.7555-0.960;P < 0.01).In all patients with cerebral ischemic stroke,FVHs detected ATA positive with a sensitivity of 83.8% and a specificity of71.7%(AUC=0.796;95%CI,0.701-0.890;P < 0.01).5.In patients with acute cerebral ischemic stroke,FVHs detected perfusion disorders with a sensitivity of 89.5% and a specificity of 93.7%(AUC=0.913;95%CI,0.505-0.869;P < 0.01);In patients with subacute cerebral ischemic stroke,FVHs detected perfusion disorders with a sensitivity of 83.3% and a specificity of 92.3%(AUC=0.890;95%CI,0.7555-0.960;P < 0.01).In all patients with cerebral ischemic stroke,FVHs detected perfusion disorders with a sensitivity of 85.5% and a specificity of 92.9%(AUC=0.900;95%CI,0.701-0.890;P < 0.01).Conclusion1.FVH can be used to diagnose perfusion disorders around the cerebral infarction.FVH can reflect the blood perfusion status of the brain tissue around the cerebral infarction.For patients who do not have the conditions to do perfusion scanning,FVH is helpful for rapid clinical evaluation of the patient’s condition and guidance of further treatment plan.2.There is a significant correlation between FVH-aspect and ATA-aspect,suggesting that the presence of FVH is helpful to evaluate the distribution of collateral circulation and judge the effect of thrombolysis.However,FVH need to be further improved to judge the specificity and sensitivity of collateral circulation directly.3.FVH/DWI mismatch is highly correlated with the index of collateral circulation(ATA)in the ASL,suggesting that FVH/DWI mismatch may be a more efficient indicator to judge the formation of collateral circulation in patients with cerebral ischemic stroke intuitively and conveniently.In conclusion,FVH provides a simple and objective imaging basis for the selection of clinical treatment plan and the evaluation of disease changes in patients with cerebral ischemic stroke.Particularly,FVH/DWI mismatch may be a convenient indicator to judge the formation of effective collateral circulation. |
