Clinical Value Of Vessel Wall Magnetic Resonance Imaging In Etiological Diagnosis Of Ischemic Stroke In Young Adults

Objective By analyzing the imaging findings of magnetic resonance vascular wall in young patients with ischemic stroke,to explore the effect of magnetic resonance vascular wall imaging on the etiological classification of young ischemic stroke and its clinical significance,and use it to observe the imaging changes of intracranial vascular wall after drug treatment.Methods The patients who were hospitalized in Nanjing Gulou Hospital from January 2014 to January 2020,aged between 16 and 45 years old,were diagnosed as acute ischemic stroke(excluding cardiogenic stroke)and were scanned by VW-MRI.The films were read by two senior radiologists,and the imaging findings of the blood vessel wall were analyzed.At the same time,the general clinical data of 92 patients and the results of routine imaging examination(CTA,MRA,DSA)were collected.Two senior neurologists performed etiological classification of all patients twice according to CISS classification criteria.In addition to referring to general clinical data,the first classification referred to the results of routine imaging examination,and the results of VW-MRI were added the second time to compare the difference between the two typing to clarify the clinical significance of VW-MRI in etiological classification of ischemic stroke in young people.All the patients in the group were followed up,and the patients who had been reexamined in our hospital after discharge were selected to observe the changes of VW-MRI after etiological treatment.Results 1.A total of 92 patients were enrolled in this study.the ratio of male to female was about 2.7,and the average age was 38 ±6.2 years old.VW-MRI suggested that the intracranial vascular lesions were large artery atherosclerosis(n =53),central nervous system vasculitis(n = 7),moyamoya disease(n = 8),cerebral artery dissection(n = 16)and no obvious abnormality(n = 8).2.According to the etiological classification criteria of CISS,there were 45 cases of LAA,7 cases of PAD,11 cases of OE and 29 cases of UE in the first classification,and 50 cases of LAA,3 cases of PAD,31 cases of OE and 8 cases of UE in the second classification.The two types were consistent in 58 cases(63.0%)and inconsistent in 34 cases.In the first classification,7 patients with LAA and 21 patients with UE were diagnosed as moyamoya disease,dissection,vasculitis and atherosclerotic plaque by VW-MRI.4 patients with perforating artery disease and 2patients with moyamoya disease showed atherosclerotic plaque on VW-MRI.Statistics showed that VW-MRI significantly reduced the proportion of stroke with uncertain etiology,and significantly increased the diagnosis rate of other etiological types,and the data were statistically significant(Kappa value: 0.343,P < 0.001)(Kappa value:0.306,P < 0.001).Compared with routine imaging examination,VW-MRI can better distinguish LAA and some rare causes,especially in the diagnosis of cerebral artery dissection and central nervous system vasculitis(Kappa value: 0.113,P < 0.001).In addition,VW-MRI can better display the location of atherosclerotic plaques,thus suggesting the pathogenesis of carrier artery occlusion of the perforator opening.3.A total of 14 patients were reviewed by VW-MRI during follow-up,including 7cases of LAA,3 cases of cerebral artery dissection and 4 cases of vasculitis.VW-MRI suggested that the 7 patients with LAA all showed different degrees of plaque volume reduction and decreased intensity after standardized treatment by the medical department.VW-MRI can dynamically observe the changes in signal intensity of intra-mural hematoma during the treatment of patients with cerebral artery dissection.It also reflects the inflammatory activity of the arteries in vasculitis.Conclusion 1.VW-MRI can detect some rare cerebrovascular diseases and accurately display atherosclerotic plaques.2.The etiology of ischemic stroke in young people is complex and diverse,which is easy to be missed and misdiagnosed,and the increase of VW-MRI examination is of great significance to the etiological classification of ischemic stroke.3.During the follow-up,the changes of vascular wall of atherosclerotic plaque,central nervous system vasculitis and cerebral artery dissection can be dynamically observed by intracranial vascular VW-MRI,which provides good imaging data for treatment and scientific research.