Study On The Correlation Between Hyperintense Vessel Sign And Cerebral Perfusion In Patients With Acute Middle Cerebral Artery Occlusion

Objective: The hypervelense vessel sign(HVS)is an imaging manifestation of the intracranial collateral circulation in patients with ischemic cerebrovascular disease on fluid-attenuated inversion recovery(FLAIR).The relationship between HVS and local cerebral blood perfusion is not clear.The purpose of our study is to explore the relationship between HVS and local cerebral blood perfusion in the patients with acute middle cerebral artery occlusion.Methods: 54 patients with acute cerebral artery occlusion were enrolled from Department of Neurology,the First Affiliated Hospital of Wannan Medical College during October 2015 to December 2016.All the patients underwent brain CT scan,magnetic resonance imaging(including DWI and FLAIR sequences),cranial magnetic resonance angiography(MRA),and CT perfusion(CTP)within 48 hours after hospitalization.The general clinical data(including gender,age,medical history,admission NIHSS score,ASPECT score),blood test results(including blood glucose,blood lipid,uric acid),and imaging findings(CT、MRI、MRA、CTP)were collected.The patients were followed up and recorded their modified Rankin scale(m RS)score after 30 days post stroke.Additional,we observed the HVS in MRI FLAIR sequence,and obtain the regional perfusion parameters of cerebral artery occlusion area and contralateral mirror area,including cerebral blood flow(CBF),cerebral blood volume(CBV),time to peak(TTP)and mean transit time(MTT).The correlation between HVS score and CTP parameter values was analyzed by Spearman correlation analysis.Results:(1)Among the patients(mean age 62.19±13.53),there were 36 cases of male (66.67%),36 cases of hypertension(66.67%),17 cases of diabetes(31.48%),10 cases of coronary heart disease(18.52%),18 cases of smoking(33.33%),11 cases of alcohol(20.37%),43 cases of HVS positive(79.63%)and 11 cases of HVS negative(20.37%);(2)In the HVS positive group,the CBF and CBV in the infarcted area were lower than these in the healthy side mirror area(t=-2.376,P=0.020;t=-2.980,P<0.01),whereas the TTP time was longer than these in the healthy side mirror area(t=4.537,P<0.01).The MTT between two groups was not statistically significant(t=0.237,P>0.05).In the HVS negative group,the CBF and CBV in the infarcted area were significantly lower than those in the healthy side mirror area(t=-4.043,P<0.01;t=-3.996,P<0.01),whereas the MTT and TTP were longer than these in the health side mirror area(t=2.194,P=0.040;t=2.182,P=0.044);(3)Spearman correlation analysis showed that the middle cerebral artery area CBF,CBV was positively correlated with HVS score(r=0.590,P<0.01;r=0.502,P<0.01),MTT and HVS scores were negatively correlated(r=-0.329,P=0.015).There was no correlation between TTP and HVS scores(r=-0.207,P=0.133);(4)Acute middle cerebral artery occlusion in patients with positive HVS infarct size(ASPECT score),admission NIHSS score and 30 dm RS score were lower than HVS negative group(Z=-2.024,P=0.043;t=2.895,P<0.01;Z=-2.060,P=0.039);(5)Single factor analysis showed that diabetes,cholesterol and triglycerides shared significant differences between the two groups(c2=5.750,P=0.016;t=2.041,P=0.046;t=2.029,P=0.048);(6)The multi-factor Logistic regression analysis showed that diabetes mellitus might be the independent risk factor for the formation of HVS(OR=4.758,95%CI 1.053~ 21.502,P<0.05).Conclusion:The presence of HVS in patients with acute middle cerebral artery occlusion might indicates better cerebral perfusion in ischemic regions,and the prognosis is better.Diabetes mellitus might be an independent risk factor for the formation of Hyperintens vessel sign(HVS)on fluid-attenuated inversion recovery(FLAIR)in patients with acute middle cerebral artery occlusion.