| Part ⅠBackground and PurposeSymptomatic atherosclerotic stenosis or occlusion of cerebral arteries can lead to acute ischemic stroke（AIS）,so endovascular recanalization can be selected for patients who are suitable for it.However,premature endovascular recanalization can still lead to hemorrhagic transformation（HT）in ischemic brain tissues with increased permeability of the blood-brain barrier（BBB）.Dynamic Contrast-enhanced（DCE）sequence can detect degree of BBB injury precisely.The purpose of this study was to investigate DCE sequence classification of BBB permeability in patients with anterior circulation subacute ischemic stroke（SIS）,and to investigate the predictive role of DCE classification in Ischemic brain tissue HT after endovascular treatment in SIS patients.MethodsThe clinical and imaging data of anterior circulation SIS patients who received endovascular recanalization and were admitted to the subdepartment of intracranial stenosis in Henan Provincial People Hospital（Henan University People Hospital）between December 2020 and February 2022 were prospectively collected.All patients received medical treatment for more than 2 weeks and DCE sequence scan before endovascular recanalization,and head CT scan within 24-72 hours after endovascular recanalization.Classification of HT was performed according to the distribution range of gadolinium leakage in infarction lesions,and the differences and similarities of HT in each classification were compared,and the BBB permeability of each classification was quantitatively determined.t test（normal distribution）,Mann-Whitney U test（skewness distribution）,χ2 test and Kruskal-Wallis test were used to analyze the dataResultsA total of 42 patients were included,of whom 9（21.43%） developed HT.None of the 11 patients（26.19%,11/42）with subtype Ⅰ developed HT.HT occurred in 3（12.50%,3/24）of the 24 patients classified as subtype Ⅱ（57.14%,24/42）,and in 6（85.71%,6/7）of 7 patients classified as subtypeⅢ（16.67%,7/42）.r Ktrans and Ktrans in the three subtypes are: subtype Ⅰ 1.9（1.3,2.1）/ 0.031（0.023,0.034）min-1,Ⅱ subtype of 2.6（2.15,3.1）/ 0.0385（0.032,0.04725）min-1,subtype Ⅲ 7.1（5.9,10）/0.077（0.066,0.084）min-1,r Ktrans and Ktrans had statistical significance in different subtypes,P<0.001.Kruskal-Wallis test: H=23.917 in the r Ktrans group,P < 0.001,there was a difference in r Ktrans among different subtypes.After pairwise comparison,there were differences in r Ktrans among the three subtypes,P < 0.05.In Ktrans group,H=21.145,P < 0.001,r Ktrans was different among different subtypes.There was no difference in Ktrans between subtype Ⅰ and subtype Ⅱ patients,P=0.077.There was a difference in Ktrans between subtype Ⅰ and subtype Ⅲ,P < 0.001.Ktrans differed between subtype Ⅱ and subtype Ⅲ patients,P=0.003.The threshold value of Ktrans for HT differentiation was 0.0535 min-1（sensitivity 88.9%,specificity 97%,P < 0.001）.The threshold of r Ktrans for HT differentiation was3.15（sensitivity 88.9%,specificity 87.9%,P < 0.001）.AUC were 0.968 and 0.929.ConclusionDCE classification is closely related to BBB permeability of SIS infarction lesions,which can individually identify the degree of BBB injury in patients and predict the risk of HT in SIS patients after endovascular treatment.Part ⅡBackground and PurposeASL sequence can be used to evaluate BBB before and after treatment for ischemic cerebrovascular disease（including intravenous thrombolytic therapy,emergency intravascular recalculation,carotid endarterectomy,intracranial arterial balloon or stent angioplasty）.In patients with symptomatic atherosclerotic cerebral infarction,premature vascular endovascular recanalization may lead to hemorrhagic transformation of ischemic brain tissue with increased BBB permeability.This study aims to observe effects of arterial spin labeling（ASL）sequences on blood-brain barrier（BBB）permeability in anterior circulation subacute ischemic stroke（SIS）patients,and the value of ASL in predicting hemorrhagic transformation（HT）after endovascular recanalization s analyzed.MethodsThe clinical and imaging data of anterior circulation subacute ischemic stroke patients admitted to Henan Provincial People Hospital（Henan University People Hospital）between December 2020 and February 2022 were prospectively collected.All SIS patients were treated with medicine for more than 2 weeks before receiving endovascular therapy,and all patients received ASL sequence and DCE（Dynamic Contrast-enhanced）sequence scan before surgery,and immediate Xper CT was performed after endovascular therapy.The role of ASL sequence in BBB assessment was cross-verified by preoperative DCE sequence and Xper CT.Statistical analysis methods: Weighted Kappa coefficient was used to evaluate the consistency of each sequence on the classification of infarct foci.T test（normal distribution）or Mann-Whitney U test（skewness distribution）was used.Fisher’s test was used to influence the factors of hemorrhage transformation.ResultsA total of 22 patients were included,including 11 patients with severe stenosis ≥70% and 11 patients with occlusion.There were 3 cases（13.63%）with balloon angioplasty alone,and 19 cases（86.36%）with balloon angioplasty and stent implantation.The responsible vessels were the middle cerebral artery in 10 cases（45.45%）,the intracranial segment of the internal carotid artery in 7 cases（31.81%）,and the extracranial segment of the internal carotid artery in 5 cases（22.72%）.The patients were divided into two groups according to the infarction location,including 4 cases（18.18%）in the cortical group and 18 cases（81.82%）in the subcortical and basal ganglia group.The weighted Kappa coefficients of ASL and DCE typing were 0.941（95%CI,0.862-1.020）,P<0.001,indicating strong consistency.The weighted Kappa coefficient of ASL typing and Xper CT typing was 0.751（95%CI,0.608-0.895）,P<0.001,showing strong consistency.HT occurred in 4 out of 6 patients with ASL imaging classification Ⅲ and 1 out of 9 patients with ASL imaging classification Ⅱ.RCBF value of HT group（5/22,22.73%）was higher than that of non-HT group（17/22,77.27%）[1.57±0.18 vs 1.14±0.04,P<0.001].Ktrans in HT group was higher than that in non-HT group [0.072（0.0455-0.117）min-1 vs 0.032（0.024-0.039）min-1,P<0.001].ConclusionsASL sequence and DCE sequence have high consistency in the detecting BBB permeability in patients with SIS,and subtype Ⅲ of ASL imaging is highly correlated with HT. |
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