Correlation Between MRI Markers Of Cerebral Small Vessel Disease And Long-Term Functional Outcome In Acute Ischemic Stroke Patients

BackgroundPeople have given more attention to the correlation between single imaging phenotype of cerebral small vessel disease(CSVD)and the prognosis of acute ischemic stroke(AIS)patients.But recent studies on the relationship between all phenotypes of CSVD and the prognosis of AIS patients are rare.The relationships between CSVD imaging phenotypes and long-term functional prognosis of AIS patients are controversial in different studies.ObjectiveThe study ranked modified Rankin Scale(mRS)of 1-year follow-up as the longterm functional prognosis and explored the factors that could cause the terrible long-term functional prognosis in AIS patients.Moreover,we found optimal cut-off points of single CSVD phenotype in predicting the poor long-term functional prognosis.The study made a scoring system based on the overall imaging phenotypes of CSVD to predict poor long-term functional prognosis and found the effects of CSVD MRI phenotypes on the long-term functional prognosis of AIS patients.Methods1112 AIS patients were studied in the research,who met the criteria and were hospitalized in the First Affiliated Hospital of Zhengzhou University,from January 2015 to December 2016.Based on the mRS scores of 1-year follow-up,AIS patients were divided into two groups: good long-term functional group(mRS score ?2)and poor long-term functional group(mRS score > 2).This research studied the difference between the two groups in demographic information and images.ROC curve was used to analyze the optimal cut-off points of poor long-term functional in AIS patients.The Nomogram based on the overall imaging phenotypes of CSVD was used to predict poor long-term functional prognosis in AIS patients.ResultsIn 1112 AIS patients,244(21.94%)had a poor functional prognosis.In the multiple logistic regression analysis,age(OR value and 95% CI: 1.778(1.259-2.512),P= 0.001),history of hypertension(OR value and 95% CI: 1.454(1.024-2.063),P= 0.036),history of stroke(OR value and 95% CI: 1.847(1.294-2.636),P=0.001,NIHSS scores in admission(OR value and 95% CI: 5.779(4.145-8.058),P<0.001),severe PWMH(OR value and 95% CI: 3.375(1.257-9.046),P=0.016),multiple lacunes(OR value and 95% CI: 1.887(1.249-2.852),P=0.003),more than 20 BG-PVS(OR value and 95% CI:1.756(1.120-2.754),P=0.014)were correlated with poor long-term functional prognosis in AIS patients,while gender,history of smoke and alcohol as well as coronary heart diseases,DWMH,mild to moderate PWMH,single lacune,mild to moderate BG-PVS(11-20),CS-PVS,ICAS were not correlated with poor long-term functional prognosis in patients with AIS(p > 0.05).The Nomogram predicting poor functional prognosis in AIS patients indicated that patients with the scores more than 197 points would have a poor long-term functional outcome,and the accuracy of the scoring system was 77.69%(50% was the segmentation point).Conclusion(1)In patients with AIS: age,NIHSS scores in admission,histories of hypertension and stroke were significantly correlated with poor long-term functional outcome,while ICAS was not correlated with poor long-term functional outcome.(2)In patients with AIS: severe PWMH was significantly correlated with poor long-term functional outcome,while mild and moderate PWMH and DWMH were not correlated with poor long-term functional outcome.(3)In patients with AIS: ?2 lacunes were significantly correlated with poor longterm functional outcome,while there was no significant correlation between single lacune and the poor long-term functional outcome.(4)In patients with AIS: more than 20 BG-PVS was significantly correlated with poor long-term functional outcome,while 11-20 BG-PVS and CSPVS were not correlated with poor long-term functional outcome.(5)The Nomogram based on the overall imaging phenotypes of CSVD indicated that AIS patients with the scores more than 197 points had a poor long-term functional outcome,and the accuracy of the scoring system was 77.69%.