RESUMO
Background: Accurately assessing the prognosis of patient with large-scale cerebral infarction caused by acute middle cerebral artery (MCA) occlusion in the early stages of onset can help clinicians to actively and effectively intervene, thus reducing mortality and disability rates. This study set out to investigate the predictive value of fluid-attenuated inversion recovery vascular hyperintensity (FVH) on collateral circulation and clinical prognosis. Methods: The clinical data of 70 patients admitted to The First People's Hospital of Lianyungang from January 2018 to December 2021 with acute cerebral infarction due to occlusion of the proximal end of the M1 segment in the MCA were retrospectively collected. All patients had their first onset of disease and did not receive thrombolytic therapy at the time of onset. Subsequently, they underwent endovascular thrombectomy for treatment. The FVH and collateral vessel scores were derived according to patients' fluid-attenuated in version recovery (FLAIR) sequence and time-of-flight magnetic resonance angiography images. Based on the 90-day Modified Rankin Scale (mRS), patients were allocated to a good prognosis group (mRS ≤2) and a poor prognosis group (mRS =3-6). The correlation between the FVH and collateral vessel scores was assessed using the Spearman rank correlation test. Pearson correlation coefficient analysis was used to assess the correlation between FVH and the 90-day mRS together with the infarct size. Univariate analysis, multivariate binary logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were adopted to identify those factors potentially. associated with the prognosis of patients with acute ischemic stroke (AIS). Results: Out of 70 patients with acute unilateral MCA occlusion (MCAO) who met the inclusion criteria, 62 showed positive FVH sign. These 62 patients were divided into a good prognosis group (n=32) and a poor prognosis group (n=30) based on the mRS score 90 days after discharge. The Spearman rank correlation test indicated that FVH was positively correlated with collateral vessel grade (Spearman rho =0.865; P<0.001); meanwhile, Pearson correlation coefficient analysis indicated that FVH score had moderate negative correlation with 90-day mRS score (r=-0.605; P<0.001). The results of multivariate binary logistic regression analysis indicated that collateral vessel grade and FVH score may be associated with the prognosis of patients with AIS, and the area under the curve (AUC) of FVH score was larger than collateral vessel grade (AUC =0.738). Conclusions: There was a positive correlation between FVH score and collateral vessel grade, and FVH score could indicate collateral circulation. FVH score was negatively correlated with 90-day mRS score and infarct volume and thus can predict clinical prognosis.
RESUMO
Objective: This study aims to explore the application value of computed tomography (CT) three-dimensional (3D) reconstruction, magnetic resonance imaging (MRI) 3D reconstruction, and conventional digital subtraction angiography (DSA) fluoroscopy in percutaneous transhepatic cholangial drainage (PTCD). Methods: The clinical data of 180 patients with obstructive jaundice requiring PTCD from December 2017 to December 2021 were retrospectively analyzed. Following PTCD, CT 3D reconstruction, MRI 3D reconstruction, and conventional DSA fluoroscopy were conducted, after which the surgical success rates, liver function results, and postsurgical complications were compared. Results: The puncture accuracies under CT 3D reconstruction, MRI 3D reconstruction, and conventional DSA fluoroscopy were 90.0% (54/60), 96.7% (58/60), and 80% (48/60), respectively. The degree of jaundice and epigastric discomfort was relieved in all three groups after surgery, while a significant reduction in the levels of total bilirubin and direct bilirubin was observed relative to the levels before surgery (P < 0.05). The incidences of complications in the CT 3D reconstruction, MRI 3D reconstruction, and conventional DSA fluoroscopy groups were 6.7% (4/60), 3.3% (2/60), and 13.3% (8/60), respectively, and the differences among the three groups were statistically significant (P < 0.05). Conclusion: Conducting conventional enhanced CT and MRI scans in patients before surgery might be more practical than the conventional puncture method. Among the methods under study, MRI 3D reconstruction was found to be safer and more feasible than CT 3D reconstruction and conventional DSA fluoroscopy in PTCD. MRI 3D reconstruction could reduce the degree of jaundice, improve the success rate of surgery, reduce the incidence of complications due to surgery, and improve the patients' tolerance to surgery.