Application Of 3D-CUBE T1 Sequence Based On HR-MRI In The Diagnosis Of Cerebral Artery Thrombosis

ObjectiveUsing digital subtraction angiography(DSA)as a reference standard,the clinical value of 3D-CUBE T1 high resolution magnetic resonance imaging(HR-MRI)sequence in the diagnosis of responsible vascular thrombosis in patients with acute and subacute cerebral infarction was evaluated by comparing with susceptibility weighted imaging(SWI).Thrombus length was measured with 3D-CUBE T1 sequence to explore the relationship between thrombus length and the degree of nervous system damage and prognosis of cerebral infarction.Materials and MethodsFrom December 2016 to December 2018,93 patients with acute or subacute cerebral infarction were collected,including 63 males and 30 females,aged 30-82 years.The onset time was 1 day to 14 days.Conventional MRI or CT scans showed that the infarcted area was located in the blood supply area of a single artery.All patients underwent magnetic resonance angiography(MRA),diffusion weighted imaging(DWI),SWI and 3D-CUBE T1 sequence scanning.(1)The location of the responsible vessel was determined by DWI sequence combined with MRA scan.DSA images were used as the reference criteria for the diagnosis of cerebral artery thrombosis.Two senior radiologists compared the diagnostic results of 3D-CUBE T1 sequence and SWI sequence with those of DSA,and recorded the truepositive,false-positive,true-negative and false-negative numbers of the two techniq ues for the diagnosis of cerebral artery thrombosis.The sensitivity,specificity,positive predictive value and negative predictive value of the two techniques in the diagnosis of cerebral artery thrombosis were measured and compared.By comparing the area under curve(AUC)of ROC curve,the diagnostic efficacy of 3D-CUBE T1 sequence and SWI sequence for responsible intravascular thrombosis was compared.Kappa test was used to measure the consistency of 3D-CUBE T1 sequence and SWI sequence with DSA in diagnostic results.(2)Patients diagnosed as thrombosis by DSA were included.The National Institutes of Health Stroke Scale(NIHSS)score was used to assess the degree of neurological impairment.The modified Rankin scale(m RS)score was followed up for 3 months to evaluate the prognosis of patients.The length of cerebral artery thrombosis was measured on 3D-CUBE T1 sequence,and the patients were divided into four groups according to NIHSS score.The differences of thrombus length,sex,age,past history of 5 diseases(type2 diabetes,hypertension,hyperlipidemia,heart disease and stroke)and smoking history were analyzed statistically.The relationship between thrombus length and NIHSS score was explored by multiple linear regression model.According to the m RS score,patients with cerebral artery thrombosis were divided into poor prognosis group and better prongosis group.Multivariate logistic regression model was used to investigate the relationship between thrombus length and clinical prognosis.Result1.64 of 93 patients with cerebral infarction were diagnosed as cerebral artery thrombosis by DSA and 29 were diagnosed as non-thrombosis.The sensitivity,specificity,positive predictive value and negative predictive value were 100%,93.1%,96.9% and 100%respectively.The SWI sequence was used to diagnose 48 cases of cerebral artery thrombosis and 45 cases of non-thrombosis.The corresponding statistical values were 73.4%,96.6%,97.9% and 62.2% respectively.The AUC value of 3D-CUBE T1 sequence in the diagnosis of acute and subacute cerebral arterial thrombosis was higher than that of SWI sequence(0.966 vs 0.850,P < 0.05).Compared with DSA reference standard,the kappa value of 3D-CUBE T1 sequence was higher than that of SWI sequence(0.949 vs 0.608,P< 0.05).2.There was no significant difference in mean age,average thrombus length,NIHSS score,m RS score and the distribution of past history of five diseases between male and female thrombus patients(P > 0.05).Smoking had statistical difference between male and female.All smokers in the group were male.3.There was significant difference in the distribution of thrombus length among different grades of NHISS scores(P < 0.05).There was no significant difference in age,sex,smoking history and the past history of five diseases among different grades of NHISS scores(P > 0.05).4.With NHISS score as dependent variable(Y)and thrombus length as independent variable(X),a multivariate linear regression model was established by using the optimal subset method.The model form was Y=0.46 X-0.70 sex-3.09.Namely,when other conditions remain unchanged,the NHISS score increases by an average of 0.46 points for each increase in thrombus length of 1 mm.5.The prognosis of patients was grouped according to the m RS score.Thrombus length was an independent risk factor for predicting the prognosis of cerebral infarction.odds ratio(OR)= 1.11 > 1,confidence interval was 1.04-1.20,P < 0.05.It is suggested that the risk of poor prognosis increases by 1.11 times with the increase of thrombus length1 mm under the same other conditions.Conclusion1.3D-CUBE T1 HR-MRI sequence can visually display the distribution and signal difference of cerebral artery thrombosis.Compared with SWI sequence,3D-CUBE T1 sequence has higher sensitivity and diagnostic efficiency,and is more consistent with DSA diagnosis.It has high clinical value for the diagnosis of thrombus in responsible vessels of patients with acute and subacute cerebral infarction.2.3D-CUBE T1 sequence can quantitatively measure thrombus.Thrombus length has a strong predictive significance for NHISS score and m RS score.The greater the length of thrombus,the higher the degree of nervous system damage,and the greater the risk of poor prognosis.