Clinical Application Value Of MR 3D CUBE T1 Combined With T2 FLAIR For Acute Middle Cerebral Artery Occlusion

Objective:For patients with acute middle cerebral artery(middle cerebral artery,MCA)occlusion,explore the craniocerebral MR 3D CUBE T1 fs sequence high signals on T1-weighted fat-suppressed images(HST1)and T2 FLAIR sequence high signals on blood vessels(FLAIR vascular hyperintensity,FVH)in the diagnosis of MCA thrombosis value.To explore the clinical significance of FVH signs in different parts and the evaluation value of clinical prognosis.At the same time,MR 3D CUBE T1 fs sequence and T2 FLAIR sequence were combined to analyze the correlation between HST1 and FVH.Materials and Methods:Collected 648 patients with acute ischemic stroke in our hospital from October2018 to December 2020.According to the study inclusion and exclusion criteria,a total of 64 patients were finally enrolled in the study,including 42 males and 22 females,with an average age of(65.1±12.1))year old.The instrument equipment adopts 3.0T MR imager(GE MR Discovery 750),and uses 8-channel head phased array coil to scan the brain.Scanning sequences include conventional MRI sequences(T1WI,T2 WI,DWI,T2 FLAIR),MRA,SWI and 3D CUBE T1 fs sequences.According to the signs displayed by the 3D CUBE T1 fs and T2 FLAIR images,the subjects were divided into two groups,namely the positive HST1 group and the positive proximal FVH group;the subjects were divided into the proximal M1 segment group according to the location of MCA vascular occlusion and thrombosis And M2 segment group.At the same time,observe whether the distal FVH sign appears on the T2 FLAIR image,and divide the study subjects into the distal FVH positive group and the no distal FVH negative group.Statistical evaluation uses SPSS 25.0 software.Continuous variables that obey normal distribution are expressed as mean±standard deviation(x±s),and independent sample T test or chi-square test is used for analysis between groups.Those that do not obey normal distribution The data is expressed as the median M(P25,P75),and non-parametric test is used for analysis between groups,P<0.05 is statistically significant.The area(Az)under the receiver operative characteristic curve(receiver operative characteristic,ROC)was used to evaluate the accuracy of the diagnosis of MCA thrombus by HST1 and proximal FVH.The Mc Nemar test was used to compare the sensitivity differences between the positive HST1 and the positive FVH,and the Kappa test was used to test the consistency between the positive HST1 and the positive near-end FVH groups.Statistics were used to analyze the correlation between the positive distal FVH sign and clinical baseline data,NIHSS score at admission,m RS score at admission,m RS score at 90 days after discharge,and infarct size.Results:1.The patient’s 3D CUBE T1 fs image performance: Among 64 patients,57 patients showed HST1 signs in the responsible MCA vessels,of which 44 patients(77.2%)had HST1 signs in the M1 segment;13 patients(22.8%)HST1 sign occurred in the M2 segment.2.The patient’s T2 FLAIR image manifestations: Of the 64 patients,45 patients were responsible for MCA intravascular manifestations of proximal FVH signs,of which 34(75.5%)patients occurred in the M1 segment;11 patients(24.4%)occurred in the M2 segment.There were 34 cases with positive distal FVH sign and 30 cases without distal FHV negative group,accounting for 53.1% and 46.9% of the total respectively.3.The clinical baseline data analysis of the positive HST1 sign group and the positive proximal FVH sign group,the age,gender,smoking history,drinking history,whether there is atrial fibrillation and other past history(including hypertension,hyperglycemia,high There was no statistically significant difference in lipemia,stroke or TIA episode history(P>0.05).4.Analyze the image data of MCA HST1 sign positive group and FVH sign positive group.Using cerebral artery DSA or CTA or MRA as the test reference standard,the area under ROC(Az)is used to evaluate the diagnostic accuracy of positive HST1 sign and positive proximal FVH sign for MCA thrombosis,among which HST1 sign is accurate for the diagnosis of MCA thrombosis The diagnostic accuracy of proximal FVH sign for middle cerebral artery thrombosis was 84.4%,and the difference was statistically significant(P<0.05).The Mc Nemar test was used to compare the sensitivity difference between the positive HST1 sign and the positive proximal FVH sign.The sensitivity of the HST1 sign was 89.0%,and the sensitivity of the proximal FVH sign was 68.8%.The difference was statistically significant(P<0.05).5.The prevalence of hypertension in the distal FVH positive group and the non-distal FVH negative group,the distal FVH positive group is lower than the non-distal FVH negative group(P<0.01),other clinical data age,gender,smoking history,drinking history,The history of atrial fibrillation and other past history(including history of hypertension,hyperglycemia,hyperlipidemia,stroke or TIA episode)were not statistically significant(P>0.05).The patients in the distal FVH positive group were relatively lower than those in the no distal FVH negative group.The NIHSS score(P<0.05)and m RS score(P<0.05)upon admission were relatively low,and the infarct size(P<0.05)was relatively low.There was no significant difference in m RS scores 90 days after discharge(P>0.05).Conclusions:1.For stroke patients with acute MCA occlusion,HST1 sign and proximal FVH sign have obvious consistency in the detection of responsible vessel occlusion and thrombosis,and the detection rate of 3D CUBE T1 fs sequence for MCA thrombus is significantly better than T2 FLAIR sequence.The 3D CUBE T1 fs sequence is a powerful tool for studying the mechanism of atherosclerotic stroke.It is feasible to determine intraluminal thrombosis in the occluded MCA.Compared with the T2 FLAIR sequence,the 3D CUBE T1 fs sequence is included in the stroke MRI program It can provide more accurate details of vascular occlusion and thrombosis in the lumen.2.The appearance of the proximal FVH sign indicates severe stenosis or occlusion of the large intracranial arteries,which can reflect thrombosis in the lumen to a certain extent.For patients with MCA occlusion,the positive distal FVH sign indicates the formation of pial collateral circulation on one side of the lesion,and the disease is mild and the infarct size is relatively small in patients without distal FVH negative.This study found that the appearance of the distal FVH sign has nothing to do with the clinical prognosis.For patients with acute MCA occlusion,the appearance of distal FVH may represent the opening of pial collateral vessels,which has a certain protective effect on ischemic penumbra.However,if early intervention and treatment are not available,the prognosis is still not optimistic.3.For stroke patients with acute MCA occlusion,a history of hypertension is a risk factor for distal FVH signs,and clinical treatment should intervene as soon as possible for this cause.