A Clinical Comparative And Correlative Study Of MRI,MRA,MRS,TCD And CT In Acute Ischemic Stroke

Objective: To get more diagnostic and therapeutic information from the acute cerebral infarct, we used Transcranial Doppler, Computed Tomography, Magnetic resonance imaging Magnetic resonance angiography and Proton magnetic resonance spectroscopy to investigate the changes and relationship of cerebrovascular, cerebral hemodynamics, metabolites in human brain tissue, morphological changes and the clinical neurologic deficit.Methods: Thirty patients with a first acute ischemic stroke involving hemispheric middle cerebral artery (MCA) territory within 24h after onset were studied. These patients were subsequently underwent Computed tomography, Magnetic resonance imaging and Magnetic resonance angiography, Transcranial Doppler after admittion (All the examinations above-mentioned were done within 24h). At the same time, six patients of them were chosed to collect Clinical neurologic deficit score from every patient at the time of examination, to undergo proton magnetic resonance spectroscopy examination and to assess the volume of cerebral infarction. Giving the data we got comparing analysis and relative analysis.Results: after admittion, TCD abnormal rate was higher than CT, mean velocity of middle cerebral artery (VmMCA)of the lesion-side was lower than the contra side and the control group,and significant difference of the mean velocity of middle cerebral artery of the lesion-side was noted when compared with the contra side and the control group(P<0.05). On conventional MRI, infarction showed that 3 cases presented to equal T1 and long T2 signal intensity uniformly slightly, whose boundary was not clear; 27 cases presented to long T2 and long T2 signal intensity uniformly slightly, whose boundary was blurred, conventional MRI abnormal rate was 100%. 30 patients with acute cerebral infarction showed high signal intensity in DWI and DWI abnormal rate was 100%. Results of MRA demonstrated left Middle Cerebral Artery Occlusion in 5 cases and right in 7 cases; cerebral arteriosclerosis in 7 cases; cerebral artery innate dysplasia in one case, and normal in 10 cases. No significant difference between TCD and MRA was noted. MRS showed the NAA of the affected hemisphere (1.38±0.12) was decreased and lower than that of non-affected hemisphere (1.77±0.26), and significant difference between the affected area and non-affected hemisphere was noted .the Lac of the affected hemisphere was significantly increased and the double peak of Lac was detected in the infarct side, but the Lac of non- affected area was not found in the Contralateral side. No significant difference of Cho and Cr in both sides .The NAA1/NAA2 (1: the affected hemisphere ,2: non-affected hemisphere)was negatively correlated with the infarct volume(r=-0.877 P=0.022<0.05),Cho1/Cho2 were positively correlated with Vm1/Vm2, the infarct volume respectively(Correlation coefficient respectively :r=0.943,P=0.005<0.05; r=0.906,P=0.013 <0.05), and the Lac1/ Cr2 was positively correlated with the infarct volume(r=0.829, P=0.042<0.05).Conclusions: Mean velocity of middle cerebral artery (VmMCA)of the lesion-side was lower in acute ischemic stroke and no significant difference was noted between TCD and MRA in the examination of cerebral artery, Combined the both, the change of cerebrovascular can be well comprehended. The presence of Lac is an extremely sentively index of the acute cerebral ischemia .The decrease of NAA and increase of Lac are factors significantly associated with the infarct volume.