Evaluation Of Collateral Circulation And Prognosis Of Acute Cerebral Infarction With The Multimodality MRI

Part 1 Evaluation of the prognosis of acute cerebral infarction with acute internal carotid artery occlusion by a new MRA-CS with entropy weightObjective:There are many ways to evaluate the collateral circulation of middle cerebral artery territory infarction,including Tan,Miteff,Maas,ASPECTS and rLMC,which are significantly different in evaluation of prognosis of acute cerebral infarction.The author propose a new collateral circulation score?MRA-CS?based on MRA,compared with Maas and rLMC,and evaluate the prognosis of cerebral infarction.Methods:A retrospective analysis of 106 patients with cerebral infarction of internal carotid artery occlusion was performed.MRA-CS,rLMC,Maas were compared with ROC.The difference between the two groups of these three scores were compared with Mann-Whitney U.Logistic regression was used to analyze the related prognostic factors.Results:The area under the curve of MRA-CS was large?AUC=0.88?.When the cutoff value was 18.5,sensitivity and specificity were 90.4%and79.6%;Followed by rLMC?AUC=0.81?.When the cutoff value was 9.5,sensitivity and specificity were 75%and 85.2%;The minimum was Maas.?AUC=0.65?,When the cutoff value was 1.5,sensitive and specific 44.4%and78.8%respectively.The high score group of MRA-CS,rLMC and Maas were higher than those in the low score group in the NIHSS?N₀?at admission,the NIHSS?N₁?after 2 weeks treatment and the prognosis?mRS<2??all P<0.003?.Logistic regression analysis showed that MRA-CS,rLMC,Maas,DWI-ASPECTS,N0,N1 were associated with clinical prognosis?all P₁<0.027?.MRA-CS and N₁ are independent evaluation factors of clinical prognosis?P₂=0.006,OR₂=0.774;P₂<0.001,OR₂=1.970?.Conclusion:The new MRA-CS score is better than rLMC and Maas in evaluating the prognosis.It indicates MRA-CS can better reflect the real condition of collateral circulation.Part 2 Effects of collateral circulation on prognostic evaluation of hyperintense vessel sign of FLAIR with acute cerebral infarctionObjective:Hyperintense vessel sign?HVS?is a marker of the collateral circulation of the cerebral ischemia.However,the Evaluation prognostic value of HVS in acute cerebral infarction is still controversial.We explores the prognostic value of HVS in different subgroups of collateral circulation.Methods:A retrospective analysis of 149 patients with acute cerebral infarction of the middle cerebral artery?MCA?occlusion was performed.The regional leptomeningeal collateral score?rLMC?were divided into rLMC?10group?n=82?and group rLMC>10?n=67?.The correlational analyses of HVS and rLMC were conducted by scatter diagram.Logistic regression was used to analyze the related prognostic factors.Results:All patients:HVS and rLMC showed a convex curve correlation?R²=0.416?;rLMC was closely related to good outcome?P₂<0.001,OR₂=0.708?,while HVS was not related to prognosis?P₁=0.263,OR₁=1.111?.rLMC?10 group:HVS and rLMC was positive correlation?R²=0.352?;HVS and rLMC were positively related to good outcome?P₁=0.004,OR₁=0.453;P₁=0.022,OR₁=0.692?,and HVS was an independent predictor of good outcome?P₂=0.048,OR₂=0.490?.RLMC>10 group:HVS and rLMC was negative correlation?R²=0.472?;HVS was negatively related to good outcome?P₁=0.005,OR₁=3.627?.rLMC was positively related to good outcome?P₁=0.001,OR₁=0.342?,rLMC was an independent predictor of good outcome?P₂=0.015,OR₂=0.396?.Conclusion:The relationship between HVS and rLMC showed a convex curve correlation.When HVS is used to predict the prognosis of acute cerebral infarction,the degree of the collateral circulation must be considered as a new factor.Part 3 Effects of collateral circulation on prognostic evaluation of asymmetrically prominent cortical veins of SWI with acute cerebral infarctionObjective:Asymmetrically prominent cortical veins?APCV?can be used to assess the range of hypoperfusion and ischemic penumbra.However,the Evaluation prognostic value of APCV in acute cerebral infarction is still controversial.We explores whether the degree of collateral circulation will affect the APCV positive rate and the prognostic value of APCV in different subgroups of collateral circulation.Methods:The consecutive 72 patients with acute cerebral infarction of the middle cerebral artery?MCA?occlusion were prospectively registered.The regional leptomeningeal collateral score?rLMC?were divided into rLMC?10 group and group rLMC>10.Spearman correlation coefficient was used to the correlation between APCV and rLMC.Logistic regression was used to analyze the related prognostic factors.The difference between the two groups of APCV were compared with Mann-Whitney U.Results:All patients:The positive rate of APCV was 76.92%,and was negatively correlated with rLMC?P=0.002,r=-0.364?;APCV was correlated with prognosis?P₁=0.018,OR₁=3.269?,but it was noan independent predictive value.rLMC?10 group:The positive rate of APCV was 47.83%,and was not correlated with rLMC?P=0.326,r=-0.200?;APCV was an nagetive independent predictor of good outcome?P₂=0.044,OR₂=8.000?.rLMC>10 group:The positive rate of APCV was 47.83%,and was not correlated with rLMC?P=0.086,r=-0.256?;APCV was not related to the prognosis?P₁=0.229,OR₁=2.068?.Conclusion:The positive rate of APCV is negatively correlated with the degree of collateral circulation.When the collateral circulation is poor,APCV was an nagetive independent predictor of good outcome.While the collateral circulation is good,APCV was not related to the prognosis.