Value of multimodal MRI in evaluating the clinical prognosis of acute cerebral infarction with unilateral middle cerebral artery stenosis
Objective To study the clinical value of multi-modal MRI in evaluating ischemic penumbra(IP)and prognosis in acute cerebral infarction patients with unilateral middle cerebral artery stenosis.Methods Clinical data were collected from 66 patients with unilateral middle cerebral artery stenosis accompanied by acute cerebral infarction,who were admitted from October 2022 to June 2023.Three-dimensional arterial spin labeling(3D-ASL),three-dimensional time leap magnetic resonance angiography(3D-TOF-MRA),and diffusion-weighted imaging(DWI)were performed before treatment after admission.Among them,48 patients underwent 3D-ASL and DWI re-examination on the 7th day of treatment,and 6 patients underwent 3D-ASL and DWI re-examination on the 30th day of treatment.According to the degree of vascular stenosis indicated by 3D-TOF-MRA,grades 0-1 were classified as severe stenosis group,and grades 2-4 as mild to moderate stenosis group.Ischemic penumbra(IP)was assessed based on the maximum DWI high signal area,3D-ASL abnormal perfusion area of the lesion,and measurement of cerebral blood flow(CBF)in the infarct core area,IP area,and contralateral mirror area,and the IP areas before and after treatment were compared between the two groups.NIHSS scoring were performed before treatment and at 7 and 30 days of treatment for comparison.Results In this study,there were 31 cases(47%)with severe stenosis in the middle cerebral artery and 35 cases(53%)with mild to moderate stenosis.Among the 46 cases(70%)with IP zone,there were 28 cases in severe stenosis group(60.9%)and 18 cases in mild to moderate stenosis group(39.1%).Comparison of CBF in the 46 cases revealed that the infarcted core area＜IP area＜contralateral mirror area(P＜0.05).Among the 32 patients who had an IP area before treatment and underwent re-examination 7 days after treatment,a reduction of IP area was observed in 10 patients with mild to moderate stenosis and 9 patients with severe stenosis(71.4%and 50.0%,respectively).Comparison of CBF before treatment and 7 days after treatment indicated statistically significant differences in both groups(P＜0.05).In addition,the CBF and its difference before treatment and 7 days after treatment were significantly different between the two groups(P＜0.05).Both groups showed a decrease in NIHSS scores after 30 days of treatment(P＜0.05).The rates of improvement,stability,and progression in mild to moderate stenosis group and severe stenosis group were 74.3%vs 54.8%,20.0%vs 38.7%,and 5.7%vs 6.5%,respectively.The difference in clinical prognosis improvement rate between the two groups was statistically significant(P＜0.001),with the mild to moderate stenosis group showing significantly better prognosis than the severe stenosis group.Conclusion The utilization of multimodal MRI technology allows for accurate evaluation of the IP area and recovery of cerebral blood flow in the IP area before and after treatment in patients with acute cerebral infarction caused by unilateral middle cerebral artery stenosis,which is of great value for follow-up and prognosis evaluation of such patients.
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