Evaluation Of Collaterals And Prognosis Using FLAIR Vascular Hyperintensity In Acute Anterior Circulation Infarction

Objective: To collect patients with acute M1-middle cerebral artery occlusion as subjects for the study.And to investigate evaluation FLAIR vascular hyperintensity(FVH)of the collateral circulation of accuracy;to assess whether FVH as the clinical indicator to judge a patient’s clinical disease severity and short-term prognosis;to analyze its influential factors.Methods: From the database of acute stroke patients admitted to the Department of Neurology of the Second Affiliated Hospital of Dalian Medical University from January 2011 to December 2016,we retrospectively selected a subset of patients with acute M1-middle cerebral artery occlusion.Finally,fifty-three patients with acute middle cerebral artery occlusion were enrolled in the study,and mean age was 60.03years(range 30 to 84 years).Among these patients,29(54.7%)patients were male.Patients included in our study had initial imaging demonstrating occlusion of proximal M1 segment of the MCA,and underwent conventional angiography to identify the responsible vessel was M1-middle cerebral artery.The MR imaging and angiograms were obtained respectively within 24 h and 72 h after admission.Distal FVH-ASPECTS was evaluated according to distal middle cerebral artery-ASPECT area(M1–M6)and angiographic collateral grade was evaluated with the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology(ASITN/SIR)Collateral Flow Grading System.All patients were classifiedinto three groups based on FVH-ASPECTS:absent FVH(0-4 scores),subtitle FVH(5-8 scores)and prominent(9-12 scores).Clinical dates were obtained and compared with different groups of FVH.Similarly,we split all patients into two groups according to ASITN/SIR Collateral Flow Grading System: poor collaterals(0-2 scores)and excellent collaterals(3-4 scores)and compared their clinical dates.Through these comparisons,we found some relative factors and further analyzed them with logistic regression analysis.Diagnostic significance of FVH in collateral flow by ROC curve analysis.Diagnostic significance of FVH in collateral flow by ROC curve analysis.Mann-Whitney U test were used for Mann-Whitney U test was performed using initial NIHSS score and 5-day NIHSS scoreResult: Distal FVH was observed 46(87%)of the 53 enrolled patients(26 male and 20 female).FVH and collateral flow were significant associated with smoking and blood pressure.In addition,FVH was associated with Diabetes mellitus and coronary artery disease.FVH-ASPECTS and ASITN/SIR Collateral Flow Grading System were significantly correlated.FVH-ASPECTS detected collateral flow with a sensitivity of 69.4% and a specificity of 93.8%(AUC=0.893;95%CI:0.808-0.977;P<0.05).The initial NIHSS score and 5day NIHSS score appeared significantly different in all FVH groups(P<0.05).FVH-ASPECTS significant associated with lower initial NIHSS score and 5-day NIHSS score.Conclusion:(1)FVH were observed in 46(87%)of the 53 patients enrolled with acute M1-middle cerebral artery occlusion.Furthermore,the presence of distal FVH was correlated with the presence of collateral flow.The rate of accurateness in diagnosing collateral flow by FVH is 96%.(2)Moreover,higher blood pressure in admission might help the build of collateral circulation and the presence of distal FVH.(3)FVH-ASPECTS have a good consistency with ASITN/SIR Collateral Flow Grading System.We suggest that FVH score detected on acute MRI can be used as a surrogate of collateral flow grade in patients with acute M1-middle cerebral artery occlusion.(4)Higher FVH-ASPECTS is associated with good clinical outcomes in patients both in initial NIHSS score and 5-day NIHSS score.