Prognostic Evaluation Of Unilateral Acute Middle Cerebral Artery Occlusion(MCAO)in Patients With Acute Infarction By Multimodal Magnetic Resonance Imaging

Objective:To study the changes of hemodynamics,cerebral perfusion and ischemic tissue in patients with acute cerebral death due to middle cerebral artery occlusion by combining conventional magnetic resonance angiography(MRA),magnetic resonance angiography(MRA),arterial spin labeling(ASL)and susceptibility weighted imaging(SWI).Brain cell metabolism was compared and analyzed to determine the ischemic condition of brain tissue,and to analyze its correlation with short-term clinical prognosis.Methods:132 patients with middle cerebral artery occlusion who were clinically and radiographically confirmed by menstruation from December 2015 to December 2018 in our hospital were collected,and 52 patients with acute cerebral infarction(within 72h)were selected.GE discovery 750 3.0t nuclear magnetic resonance was used for multimodal magnetic resonance,and the examination sequences included conventional sequences(T1WI,T2WI,FLAIR,DWI),MRA,ASL,and SWI examination.To analyze the clinical significance and correlation of FLAIR hyperintense vessel sign(HVS),ASL-DWI mismatch(PDM)and asymmetric venous sign(AVS),and to analyze the consistency of 44 cases of HVS with PDM,38 cases of PDM with AVS,46 cases of HVS with AVS.Forty-one cases with FLAIR distal hyperintensity were grouped according to the presence or absence of asymmetrical venous signs.NIHSS scores were performed on the day of admission and the 7th day,to analyze the relationship between asymmetrical venous signs and short-term clinical prognosis.Results:there was a consistent diagnostic efficacy between HVS and PDM in 44 patients(P<0.05),and the consistency was moderate(Kappa=0.424).The diagnostic efficacy of 38 cases of PDM and AVS was consistent(P<0.05),and the consistency was general(Kappa=0.232).There was no consistency in diagnostic efficacy between HVS and AVS in 46 cases(P>0.05).Among the 41 patients with distal HVS(+),AVS 25/41(60.9%)was present,while AVS 16/41(39.1%)was not shown.There was no statistically significant difference in clinical NIHSS score between the two groups on the day of admission(P>0.05),while there was statistically significant difference in clinical NIHSS score between the two groups on the7th day of admission(P<0.05).The clinical NIHSS score of the AVS positive group on day 7 was slightly higher than that on the day of admission,but the difference was not statistically significant(P>0.05).The clinical NIHSS score of the AVS negative group on day 7 was significantly decreased,which was significantly different from that on the day of admission(P<0.05).Conclusion:The patient has acute cerebral infarction with middle cerebral artery occlusion,HVS showed that there might be hypoperfusion area around the infarct core,and AVS might exist in the presence of PDM,that is,severe ischemia area.When HVS was positive,the short-term prognosis of brain tissue was significantly correlated with the presence of AVS.Combined application of multimodal magnetic resonance imaging can evaluate the hemodynamic changes,perfusion status of brain tissue and metabolism status of brain cells around infarction,and provide important reference for clinical selection of appropriate treatment options and evaluation of short-term clinical prognosis.