Evaluation and prognosis of collateral circulation with modified MRA-MTC-RLMC score in patients with chronic middle cerebral artery occlusion

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• Clinical Article •

XU Kaixi XU Min MA Xianjun ZUO Taosheng XU Xingru DU Qing BIAN Guangrong GU Baodong

Cite this article as: Xu KX, Xu M, Ma XJ, et al. Evaluation and prognosis of collateral circulation with modified MRA-MTC-RLMC score in patients with chronic middle cerebral artery occlusion[J]. Chin J Magn Reson Imaging, 2022, 13(12): 69-73, 86. DOI:10.12015/issn.1674-8034.2022.12.012.

Abstract

[Abstract] Objective To investigate the application of regional Leptomeningeal Collateral (rLMC) score of magnetization transfer contrast (MTC) technology in magnetic resonance angiography (MRA) and the prognostic value of collateral circulation in different states of chronic middle cerebral artery occlusion (CMCAO).Materials and Methods Seventy CMCAO patients underwent routine MRI, diffusion weighted imaging (DWI) and MRA examinations. There were 39 males and 31 females, aged 46-90 (66.60±10.358) years. The best cut-off value for predicting poor prognosis of CMCAO based on modified regional leptomeningeal collateral (MRA-MTC-RLMC) score was 11, namely, >11 score was divided into good group and ≤11 score was divided into poor group. The patients were followed up for 1 month to 6 years, and were divided into good and poor prognosis group according to the end point of stroke recurrence or death during the follow-up period. The independent sample t-test, Mann-Whitney U or χ² test were used to analyze the general clinical data of patients, and multivariate logistic regression analysis was performed for variables with univariate difference of P＜0.1. The odds ratio of risk factors to end events was analyzed. Receiver operating characteristic (ROC) curve was used to analyze the value of MRA-MTC-rLMC score in predicting the poor prognosis of CMCAO patients.Results In 70 patients with CMCAO, MRI showed no lacunar infarction in 42 cases (60%), ipsilateral lacunar infarction in 17 cases (24.28%), contralateral lacunar infarction in 7 cases (10%), bilateral cerebral infarction in 4 cases (5.71%). MRA showed that 29 cases (41.43%) were on the right side and 41 cases (58.57%) were on the left side. There were 42 cases (60%) in the good MRA-MTC-RLMC group and 28 cases (40%) in the poor MRA-MTC-RLMC group. In the poor prognosis group, 18 patients had cerebral infarction, 8 patients had transient ischemic attack and 2 patients died. After adjusting for age, multivariate logistic regression analysis showed that MRA-MTC-RLMC score was a risk factor for poor prognosis of CMCAO, and there was a significant negative correlation between MRA-MTC-RLMC score and poor prognosis. The area under the ROC curve of MRA-MTC-RLMC score in predicting the poor prognosis of CMCAO was 0.855 (95% CI: 0.805-0.965), and there was significant statistical significance (P＜0.001). The optimal cut-off value of MRA-RLMC score was 11 points, and the Youden index was 0.764, the sensitivity was 96.4%, and the specificity was 81.0%, indicating that the MRA-MTC-RLMC score had a good application value in predicting the poor prognosis of CMCAO.Conclusions The modified MRA-MTC-rLMC score can provide morphological changes of CMCAO collateral vessels and indirectly reflect hemodynamics, which is conducive to early diagnosis and prognosis of CMCAO collateral circulation.

[Keywords] chronic middle cerebral artery occlusion；collateral circulation score；improved；magnetic resonance imaging；magnetic resonance angiography；magnetization transfer contrast；prognosis

Contributor Information

XU Kaixi¹ XU Min^1* MA Xianjun² ZUO Taosheng¹ XU Xingru¹ DU Qing² BIAN Guangrong² GU Baodong^2*

¹ Department of Imaging, Lianyungang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Affiliated Lianyungang Hospital of TCM of Kangda College of Nanjing Medical University, Lianyungang 222004, China

² Department of Encephalopathy, Lianyungang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Affiliated Lianyungang Hospital of TCM of Kangda College of Nanjing Medical University, Lianyungang 222004, China

Xu M, E-mail: 704050007@qq.com Gu BD, E-mail: 912695497@qq.com

Conflicts of interest None.

Publication Information

ACKNOWLEDGMENTS Jiangsu Provincial Special Program of Medical Science (No. BE2021604).

Received 2022-06-16

Accepted 2022-11-29

DOI: 10.12015/issn.1674-8034.2022.12.012

Text

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