FVH Combined With APVS In Acute Anterior Circulation Ischemic Stroke: Prediction Of Collateral Circulation And Clinical Outcome

Objective: Acute ischemic stroke(AIS)is one of the leading causes of death and disability in Chinese residents.Early diagnosis and effective intervention are crucial.Good collateral circulation can protect the blood flow of ischemic penumbra,prolong the rescue time,reduce nerve injury and improve the clinical prognosis of patients.The relationship between early specific imaging markers and collateral circulation as well as prognosis has been an urgent clinical issue to be resolved.In recent years,FALIR vascular hyperintensity(FVH)and SWI asymmetric prominent veins sign(APVS)have become a research hotspot.Previous researches have demonstrated that FVH and APVS can assess hypoperfusion in ischemic region at early stage,reflect the ischemic penumbra and collateral circulation,which may be relevant to the prognosis.Currently,domestic and foreign studies mostly focused on the relationship between FVH or APVS and collateral circulation as well as prognosis,while few studies combining the two.Therefore,the aim of this study was to explore the correlation between FVH and APVS and the value of their combination in evaluating the functional prognosis of patients with anterior circulation AIS,providing an imaging basis for the assessment of blood perfusion,the severity of stroke and the functional prognosis.Methods: For the duration of July 2021 to September 2022,patients with acute anterior circulation AIS due to severe stenosis(over ≥ 70%)or occlusion of the internal carotid artery(ICA)or the M1 segment of the middle cerebral artery(MCA),who were admitted to the Department of Neurology of the Fourth Clinical Medical College of Qingdao University were collected retrospectively.All patients underwent multimodal brain MRI scans within 72 hours of onset,including T1 WI,T2WI,DWI,MRA,FLAIR,and SWI sequences.The Alberta Stroke Program Early CT Score(ASPECTS)was used to evaluate the volume of infarction on DWI,the degree of FVH and APVS.The correlation between FVH-ASPECTS and APVS-ASPECTS score was tested using Spearman correlation analysis.At the same time,basic clinical and imaging data such as demographic data,previous vascular risk factors,the National Institutes of Health Stroke Scale(NIHSS)score at admission,the time between onset and completion of MRI examination were recorded for all enrolled patients.At 90 days of onset,functional prognosis was assessed using the modified Rankin Scale score(m RS)and divided into good prognosis and poor prognosis group.The good prognosis was defined as a score of0-2 on the m RS.Logistic regression analysis was used to explore the relationship between FVH and APVS and functional prognosis,and receiver operating characteristic(ROC)curves were plotted to assess the diagnostic efficacy of FVH and APVS in predicting poor prognosis.Results: Of the 86 patients included,74(86.0%)were FVH positive and 61(70.9%)were APVS positive.A spearman correlation analysis revealed a moderate positive correlation between FVH score and APVS score(r=0.586,P<0.001).There were 48 patients with good prognosis and 38 patients with poor prognosis.Univariate analysis revealed that compared to the good prognosis group,the patients with poor prognosis had a higher proportion of history of atrial fibrillation(34.2% vs 12.5%,P=0.016),a higher NIHSS score [12.0(9.00-16.00)vs 6.00(4.00-8.00),P<0.001],a larger DWI infarction volume [6.00(4.75-7.25)vs 3.00(2.00-4.00),P<0.001],a higher FVH-ASPECTS score[5.00(4.00-6.00)vs 2.00(0.25-3.00),P<0.001] and APVS-ASPECTS score [6.00(4.00-7.00)vs 2.00(0-4.00),P<0.001].No statistically significant difference was observed between the remaining clinical and imaging data(P>0.05).Multivariate logistic regression analysis showed that the admission NIHSS score,the infarction volume,the FVH-ASPECTS score and APVS-ASPECTS score were independently associated with poor prognosis(OR 1.869,95% CI [1.107-3.155],P=0.019;OR 3.104,95% CI [1.104-8.730],P=0.032;OR 2.485,95% CI [1.145-5.390],P=0.021;OR 1.801,95% CI [1.094-2.965],P=0.021).The area under the ROC curve(AUC)for evaluating prognosis with FVH and APVS were 0.899 and 0.818,with sensitivity and specificity of 0.868,0.833;0.665,0.937 respectively,and combining the two to assess AUC reached 0.921,with sensitivities and specificities of 0.868 and 0.896.Conclusions: In patients with anterior circulation AIS without reperfusion therapy,the presence of FVH and APVS can provide a comprehensive assessment of collateral circulation from the perspective of vein and artery.The two indicators can be used as independent risk factors in assessment of poor prognosis at 90 days,and their combination is complementary and can improve the predictive value.