Application Value Of Arterial Spin Labeling In Patients With Severe Stenosis/Occlusion Of Anterior Circulation Large Vessels

Objective: Cerebrovascular disease caused by severe stenosis / occlusion of anterior circulation large vessels is an important type of ischemic cerebrovascular disease,and it has a high recurrence rate and disability rate.This study mainly explored the application value of arterial spin labeling(ASL)in patients with severe stenosis / occlusion of anterior circulation large vessels without reperfusion therapy.Methods: Sequential collection of clinical and imaging data from patients with severe stenosis / occlusion of the anterior circulation large vessels who had not received reperfusion therapy in the Department of Neurology of the Affiliated Hospital of Qingdao University from June 2017 to June 2019.Within 72 hours of admission,magnetic resonance imaging(MRI)routine scanning T1 weighted imaging(T1WI),T2 weighted imaging(T2WI),fluid attenuation inversion recovery(FLAIR)and diffusion weighted imaging(DWI),magnetic resonance angiography(MRA)or CT angiography(CTA),ASL examination were performed.The patient's basic demographic and clinical data,the location and degree of severe stenosis or occlusion of vessels,and cerebral blood flow(CBF)are evaluated and recorded based on the examination results.It is divided into symptomatic group and asymptomatic group according to the presence or absence of symptoms of neurological deficit;according to the presence or absence of DWI and the duration of symptoms,the patients were divided into cerebral infarction group and transient ischemic attack(TIA)group;assess the prognosis of patients with cerebral infarction based on the modified Rankin Scale(mRS)score at 3 months,the mRS score ? 2 was divided into a good prognosis group,and the mRS score> 3 was divided into a poor prognosis group.Univariate and multivariate logistic regression analysis was used to analyze the independent risk factors of symptoms,ischemic stroke,and poor prognosis after ischemic stroke in patients with severe stenosis / occlusion of anterior circulation large vessels;and Spearman correlation was used to further analyze the narrow side CBF(PLD = 2.5s)was related to the baseline score of National Institutes of Health Stroke Scale(NIHSS),the score of NIHSS at 14 days after stroke,infarct volume and prognosis.Results: A total of 172 patients were finally included in the study,including 122 males and 50 females;aged from 31 to 92 years with an average of(63.33 ± 10.63)years.Of the 172 patients,129 were symptomatic and 43 were asymptomatic.Compared with patients in the asymptomatic group,the uric acid was lower in the symptomatic group,and the CBF(PLD = 1.5s and 2.5s)on the narrow side and the normal side were lower,the difference was statistically significant(P <0.05);multivariate logistic regression analysis showed that CBF on the narrow side(PLD = 1.5s)(OR = 1.048,95% CI: 1.002-1.096,P = 0.039)was an independent protective factor for symptoms in patients with severe stenosis / occlusion of anterior circulation large vessels.Of the 129 symptomatic patients,109 were in the ischemic stroke group and 20 were in the TIA group.Compared with patients in the TIA group,the ischemic stroke group had higher fasting blood glucose,lower diastolic blood pressure at admission,and lower CBF(PLD = 2.5s)on the stenosis side,the difference was statistically significant(P <0.05);multivariate logistic regression analysis showed that the diastolic blood pressure at admission(OR = 1.071,95% CI: 1.023-1.122,P = 0.003)and CBF at the stenosis side(PLD = 2.5s)(OR = 1.035,95% CI: 1.004-1.066,P = 0.027)were independent protective factors for ischemic stroke in patients with symptomatic severe stenosis / occlusion of anterior circulation large vessels.Of the 109 patients with ischemic stroke,34 had a poor prognosis and 75 had a good prognosis.Compared with the good prognosis group,the patients with a poor prognosis group had lower uric acid,higher baseline score of NIHSS,larger cerebral infarction volume,and narrow side CBF(PLD = 1.5s and 2.5s)was lower than the normal side,the difference was statistically significant(P <0.05);multivariate logistic regression analysis showed that the admission systolic blood pressure(OR = 0.966,95% CI: 0.938-0.994,P = 0.018)was an independent risk factor for poor prognosis of patients with severe stenosis / occlusion of anterior circulation large vessels of ischemic stroke;uric acid(OR = 1.008,95% CI: 1.001-1.015,P = 0.038),stenosis side CBF(PLD = 2.5s)(OR = 1.142,95% CI: 1.034-1.261,P = 0.009)were independent protective factors for the prognosis of ischemic stroke patients with severe stenosis/occlusion of anterior circulation large vessels.Spearman correlation analysis showed that there was a significant correlation between stenotic CBF(PLD = 2.5s)and the score of NIHSS at 14 days after stroke(correlation coefficient-0.752,P <0.001),infarct volume(correlation coefficient-0.302,P = 0.001),prognosis(correlation coefficient 0.459,P <0.001);the predictive value of the narrow sided CBF(PLD = 2.5s)evaluated by the working characteristics(ROC)curve of patients with severe stenosis / occlusion of anterior circulation large vessels showed that the predicted c-statistic was 0.786(CI: 0.691-0.881,P <0.001).Conclusions:(1)CBF on the narrow side(PLD = 1.5s)was an independent protective factor for symptoms of neurological deficit in patients with severe stenosis / occlusion of anterior circulation large vessels.(2)The diastolic blood pressure at admission and CBF at the stenosis side(PLD = 2.5s)were independent protective factors for ischemic stroke in patients with symptomatic severe stenosis / occlusion of anterior circulation large vessels.(3)The admission systolic blood pressure,uric acid and stenosis side CBF(PLD = 2.5s)were independent predictors for poor prognosis of patients with severe stenosis / occlusion of anterior circulation large vessels of ischemic stroke(4)The CBF measured by the ASL has certain predictive value for the occurrence of symptoms,ischemic stroke and prognosis of ischemic stroke in patients with severe stenosis / occlusion of anterior circulation large vessels,the ASL has good application value in patients with severe stenosis / occlusion of anterior circulation large vessels.