Effect Of FLAIR Vascular Hyperintensity Combined With Perfusion Weighted Imaging On Outcomes In Acute Anterior Circulation Cerebral Infarction Patients

Objective The magnetic resonance fluid attenuation inversion recovery sequence vascular high signal sign(FVH)can be used to determine the prognosis of patients with cerebral infarction,but the results are still controversial,and cerebral perfusion and cerebral infarction patients are not combined with FVH for analysis and evaluation.This study investigated the effect of FVH combined with perfusion weighted imaging(PWI)on the short-term prognosis of patients with acute anterior circulation cerebral infarction(AACCI).Methods From January to December 2018,63 patients with AACCI were hospitalized in the Department of Neurology,the Third Affiliated Hospital of Anhui Medical University.They were divided into 27 FVH-positive groups and36 FVH-negative groups based on fluid attenuation inversion recovery images.Compare age,sex,hypertension,diabetes,smoking,alcohol consumption,triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL),high-density lipoprotein cholesterol(HDL),and homocysteine level,severity of disease,vascular stenosis and 3-month prognosis in two groups of patients.According to the PWI-diffusion weighted imaging(DWI)situation,it was divided into 44 cases in the matching group and 19 cases in the non-matching group.The age,onset time,gender,cerebral infarction volume,NIHSS score,and 3-month prognosis of the matched and unmatched groups were compared.The National Institutes of Health Stroke Scale(NIHSS)score and a modified Rankin scale score at 90 days after discharge were used.Depending on whether the prognosis is good,FVH,age,gender,hypertension,diabetes,smoking,drinking,TG,TC,LDL,HDL,homocysteine,cerebral infarction volume,NIHSS score,and PWI-DWI mismatch,etc.The factors were independent variables.Logistic regression analysis of univariate and multivariate Enter methods was used to analyze the prognostic factors of patients with AACCI.FVH combined with PWI-DWI was used to determine the prognosis of patients with AACCI.Results The study included 63 patients with AACCI,the NIVS score of the FVH positive group(t =-2.347,p <0.05),poor prognosis(χ2=5.452,p <0.05),and cerebral infarction volume(z =-2.910,p <0.05)were significantly higher than those in FVH negative group,the difference was statistically significant;and the proportion of severe stenosis and occlusion was significantly higher than the FVH negative group,the difference was statistically significant(25.9% vs 5.6%,29.6% vs 2.8%,P <0.01).There was no significant difference in age,onset time,sex,volume of cerebral infarction and NIHSS scores between PWI-DWI mismatch and matching group(P >0.05).The incidence of poor outcome was significantly higher in matched PWI-DWI group than in mismatched PWI-DWI group(P<0.01).Single factor logistic regression analysis showed that FVH,cerebral infarction volume and PWI-DWI mismatch were the prognostic factors(P <0.05,P <0.01).Significant influencing factors were substituted into the multi-factor Enter method Logistic regression analysis.It was shown that FVH(OR = 4.949,95% CI: 1.138 ～ 21.532,P = 0.033)and cerebral infarction volume(OR = 1.139,95% CI: 1.008 ～ 1.287,P = 0.037)were risk factors for poor prognosis;PWI-DWI mismatch(OR = 15.510,95% CI: 2.744-87.660,P =0.002)is a good prognostic protective factor.In the FVH positive group,the proportion of PWI-DWI mismatch and good prognosis was 29.6%(8/27),and the proportion of PWI-DWI mismatch but poor prognosis was 7.4%(2/27);PWI-DWI matched but good prognosis The proportion was 7.4%(2/27).The proportion of PWI-DWI matching but with a poor prognosis was 55.6%(15/27),and the difference was statistically significant(P = 0.001).In the FVH negative group,24 patients had a good prognosis,12 patients with poor prognosis,the FVH negative combination with PWI-DWI mismatch was not statistically significant(p >0.05).Therefore,patients with positive FVH combined with PWI-DWI mismatch have a good prognosis.Conclusions FVH positive indicates stenosis or occlusion of blood vessels in patients with AACCI,and the condition is relatively serious.The mismatch between FVH and PWI-DWI can be used as an index to evaluate the prognosis of 3 months in AACCI patients.For patients with FVH and PWI-DWI mismatch,the prognosis is good.