Predictors of short-term outcome in patients with acute middle cerebral artery occlusion: unsuitability of fluid-attenuated inversion recovery vascular hyperintensity scores

Fluid-attenuated inversion recovery(FLAIR) vascular hyperintensity(FVH) is used to assess leptomeningeal collateral circulation, but clinical outcomes of patients with FVH can be very different. The aim of the present study was to assess a FVH score and explore its relationship with clinical outcomes. Patients with acute ischemic stroke due to middle cerebral artery M1 occlusion underwent magnetic resonance imaging and were followed up at 10 days(National Institutes of Health Stroke Scale) and 90 days(modified Rankin Scale) to determine short-term clinical outcomes. Effective collateral circulation indirectly improved recovery of neurological function and short-term clinical outcome by extending the size of the pial penumbra and reducing infarct lesions. FVH score showed no correlation with 90-day functional clinical outcome and was not sufficient as an independent predictor of short-term clinical outcome.

Application of MAGnetic resonance imaging compilation in acute ischemic stroke

BACKGROUND Synthetic magnetic resonance imaging(MRI)MAGnetic resonance imaging compilation(MAGiC)is a new MRI technology.Conventional T1,T2,T2-fluidattenuated inversion recovery(FLAIR)contrast images,quantitative images of T1 and T2 mapping,and MAGiC phase sensitive inversion recovery(PSIR)Vessel cerebrovascular images can be obtained simultaneously through post-processing at the same time after completing a scan.In recent years,studies have reported that MAGiC can be applied to patients with acute ischemic stroke.We hypothesized that the synthetic MRI vascular screening scheme can evaluate the degree of cerebral artery stenosis in patients with acute ischemic stroke.AIM To explore the application value of vascular images obtained by synthetic MRI in diagnosing acute ischemic stroke.METHODS A total of 64 patients with acute ischemic stroke were selected and examined by MRI in the current retrospective cohort study.The scanning sequences included traditional T1,T2,and T2-FLAIR,three-dimensional time-of-flight magnetic resonance angiography(3D TOF MRA),diffusion-weighted imaging(DWI),and synthetic MRI.Conventional contrast images(T1,T2,and T2-FLAIR)and intracranial vessel images(MAGiC PSIR Vessel]were automatically reconstructed using synthetic MRI raw data.The contrast-to-noise ratio(CNR)values of traditional T1,T2,and T2-FLAIR images and MAGiC reconstructed T1,T2,and T2-FLAIR images in DWI diffusion restriction areas were measured and compared.MAGiC PSIR Vessel and TOF MRA images were used to measure and calculate the stenosis degree of bilateral middle cerebral artery stenosis areas.The consistency of MAGiC PSIR Vessel and TOF MRA in displaying the degree of vascular stenosis with computed tomography angiography(CTA)was compared.RESULTS Among the 64 patients with acute ischemic stroke,79 vascular stenosis areas showed that the correlation between MAGiC PSIR Vessel and CTA(r=0.90,P<0.01)was higher than that between TOF MRA and CTA(r=0.84,P<0.01).With a degree of vascular stenosis>50%assessed by CTA as a reference,the area under the receiver operating characteristic(ROC)curve of MAGiC PSIR Vessel[area under the curve(AUC)=0.906,P<0.01]was higher than that of TOF MRA(AUC=0.790,P<0.01).Among the 64 patients with acute ischemic stroke,39 were scanned for traditional T1,T2,and T2-FLAIR images and MAGiC images simultaneously,and CNR values in DWI diffusion restriction areas were measured,which were:Traditional T2=21.2,traditional T1=-6.7,and traditional T2-FLAIR=11.9;and MAGiC T2=7.1,MAGiC T1=-3.9,and MAGiC T2-FLAIR=4.5.CONCLUSION The synthetic MRI vascular screening scheme for patients with acute ischemic stroke can accurately evaluate the degree of bilateral middle cerebral artery stenosis,which is of great significance to early thrombolytic interventional therapy and improving patients’quality of life.

Effect of MR Field Strength on the Texture Features of Cerebral T2-FLAIR Images: A Pilot Study

Objective To investigate effect of MR field strength on texture features of cerebral T2 fluid attenuated inversion recovery(T2-FLAIR)images.Methods We acquired cerebral 3 D T2-FLAIR images of thirty patients who were diagnosed with ischemic white matter lesion(WML)with MR-1.5 T and MR-3.0 T scanners.Histogram texture features which included mean signal intensity(Mean),Skewness and Kurtosis,and gray level co-occurrence matrix(GLCM)texture features which included angular second moment(ASM),Contrast,Correlation,Inverse difference moment(IDM)and Entropy,of regions of interest located in the area of WML and normal white matter(NWM)were measured by ImageJ software.The texture parameters acquired with MR-1.5 T scanning were compared with MR-3.0 T scanning.Results The Mean of both WML and NWM obtained with MR-1.5 T scanning was significantly lower than that acquired with MR-3.0 T(P<0.001),while Skewness and Kurtosis between MR-1.5 T and MR-3.0 T scanning showed no significant difference(P>0.05).ASM,Correlation and IDM of both WML and NWM acquired with MR-1.5 T revealed significantly lower values than those with MR-3.0 T(P<0.001),while Contrast and Entropy acquired with MR-1.5 T showed significantly higher values than those with MR-3.0 T(P<0.001).Conclusion MR field strength showed no significant effect on histogram textures,while had significant effect on GLCM texture features of cerebral T2-FLAIR images,which indicated that it should be cautious to explain the texture results acquired based on the different MR field strength.