| Objective:We aimed to investigate the value of Apparent Diffusion Coefficient（ADC）value of magnetic resonance imaging in predicting the prognosis of patients with acute posterior circulation cerebral infarction underwent endovascular therapy,screening patients with acute posterior circulation stroke suitable for endovascular treatment.Methods:A systematic retrospective analysis was conducted on 68 cases of patients hospitalized in neurology department of Shenyang First People’s Hospital and the Fourth Affiliated Hospital of China Medical University from January 2017 to December2021.Patients with acute posterior circulation cerebral infarction were confirmed by Diffusion Weighted Imaging（DWI）-ADC or DWI imaging examination within 24 hours after onset.The region of interest（midbrain,pons and thalamus）is the largest cross-section of the responsible focus in the new infarct area in magnetic resonance DWI imaging or DWI-ADC imaging,and conforms to the distribution of the responsible vessel infarct focus.Use ZLPACS ADViewer to delineate the region of interest and obtain its ADC value,or use the formula ADC=ln（S0/S1）/（b1-b0）to calculate the ADC value in DWI-B1 and B1000 images.According to modified Rankin Scale（m RS）score 3 months after endovascular treatment（EVT）,the score of 0-3 was defined as the good prognosis group（30 cases）and 4-6 as the poor prognosis group（38 cases）.The relevant data of eligible patients were collected and recorded retrospectively.The basic information such as patient information and ADC value of infarct area were compared between the two groups.SPSS 26.0 software was used to compare the clinical data of the two groups,such as ADC value of infarct area,single and bilateral infarct,NIHSS score and so on.Multivariable Logistic regression analysis further analyzed the influence of various independent variables on ADC value correction.To verify whether high ADC value in infarct area is a protective factor for good prognosis after EVT.Receiver operating characteristic（ROC）curve was used to predict and the predictive indexes were evaluated.Results:1.A total of 68 patients were included in the study,there were 30 patients with favorable outcome after EVT,and 38 with unfavorable outcomes.Univariate analysis showed that the ADC value in patients with favorable outcome（m RS 0-3 at 90 days）was significantly higher than that in patients with unfavorable outcome（m RS 4-6 at 90 days）（602.60±62.148 vs 542.21±75.914;p<0.01）.2.Multivariate analysis showed that male（OR=0.07,95%CI 0.007-0.7;p=0.024）,mean value of ADC in the Infarct area（OR=0.984,95%CI 0.972-0.996;p=0.01）,unilateral infarction（OR=0.153,95%CI 0.024-0.967;p=0.046）were independent protective factors for favorable outcome after EVT in stroke patients.3.The cut-off value of ADC of the affected region to differentiate favorable from unfavorable outcome after EVT was 555.5*10-6 mm~2/s,with sensitivity of 55.3%,specificity of 86.7%,Youden index of 0.419,and area under curve of 0.740（95%CI0.623-0.857）,p<0.05.High preoperative circulating EVT is an independent predictor of postoperative prognosis in patients with stroke.Unilateral infarct lesions combined with preoperative ADC value of infarct area>555.5*10-6 mm~2/s can predict the good prognosis of patients,with sensitivity of 81.58%,specificity of 80%,Youden index of0.616,and area under curve of 0.824（95%CI 0.713-0.906）,p<0.001.Conclusion:For patients with posterior circulation ischemic stroke,the preoperative infarct ADC value can predict the clinical outcome of patients with posterior circulation stroke after EVT.Therefore,the ADC value can be used to guide the treatment of patients with posterior circulation ischemic stroke,especially the intravascular treatment of patients with posterior circulation infarction.At the same time,it can also screen patients suitable for intravascular treatment to help patients with posterior circulation stroke obtain better prognosis and outcome. |
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