Correlation And Predictive Value Of Basal Ganglia Enlargement Of Perivascular Space In Cancer-associated Ischemic Stroke

Objective:Cerebrovascular disease,especially ischemic stroke,is probably the most common neurological disease in patients with cancer,and its incidence is second only to metastatic disease.Related research shows that about 20%-40%of patients with cancer and ischemic stroke do not find common risk factors for ischemic stroke.Related mechanisms of cancer may cause ischemic stroke,which is called cancerassociated ischemic stroke.Among them,patients with occult cancer have fewer cases with ischemic stroke as the first manifestation,and the incidence is only 0.4%of patients with cancer-associated ischemic stroke.The incidence of cerebral small vessel disease is reportedly higher among patients with cancer-associated ischemic stroke,and enlarged perivascular spaces(PVS)are a marker of cerebral small vessel disease.The present study aimed to evaluate the association of severe enlarged basal ganglion PVS(BG-PVS)with cancer-associated ischemic stroke and explore whether BG-PVS can predict ischemic stroke patients with hidden cancer,which provide assistance for early disease intervention.Methods:We retrospectively included all patients with cancer with ischemic stroke in our institution between January 2014 and December 2018 who met the inclusion criteria.The severity of BG-PVS was graded in the basal ganglia using highresolution magnetic resonance imaging(MRI).Risk factors,biomarkers,and MRI findings were compared between stroke patients with and without cancer.Results:Ninety-two patients with cancer-associated ischemic stroke(60 men and 32 women)and 92 age-and sex-matched patients with general stroke were included.There were increased levels of D-dimers and infarcts in multiple arterial blood supply areas in the cancer-associated ischemic stroke groups(P=0.016,P<0.001,respectively).Perivascular spaces were more frequently diffusely distributed in the basal ganglia in the cancer-associated ischemic stroke groups than in the general stroke group(P=0 001);however,there were no differences between patients with cancer with stroke as the first manifestation and those with post-stroke cancer.When using degree 4 BG-PVS,high levels of D-dimers and multiple territory infarctions,the sensitivity and specificity for ischemic stroke patients with hidden cancer were 70.6%and 88.1%,respectively.Conclusions:Cancer-associated ischemic stroke involves more severe BG-PVS.The pathophysiological mechanism and clinical significance of BG-PVS in cancerassociated ischemic stroke warrant further investigation.We propose that serious BGPVS combining high levels of D-dimers and multiple territory infarctions may be used as a forecasting tool to detect ischemic stroke patients with hidden cancer.