Multimodal Nuclear Magnetic Imaging Prediction of Early Neurological Deterioration in Patients with Acute Stroke Using Intravenous Thrombolysis

Background: To explore the relationship between Signal intensity ratio (SIR) levels, a cerebral hemodynamic index, and early neurological function deterioration in patients with acute cerebral infarction under the guidance of multimodal nuclear magnetic resonance imaging (NMRI) with intravenous thrombolysis. Methods: 157 patients with acute cerebral infarction who received intravenous thrombolysis within 4.5 hours of stroke were obtained from Tianjin Huanhu Hospital between January 2022 and February 2024. early neurological deterioration (END) was defined as an increase in National Institutes of Health Stroke Scale (NIHSS) score of ≥4 points from baseline at 24 hours after intravenous thrombolysis or death. The patients were divided into 36 cases in the END group and 121 cases in the non-END group. Baseline, clinical, and imaging data were collected from patients. Patients who received treatment were followed for 3 months. Magnetic resonance angiography (MRA) was used to determine SIR levels before and after thrombolysis and to analyze the correlation between SIR levels and END. Results: Patients in the END group had higher baseline systolic blood pressure, diastolic blood pressure, post-thrombolysis hemorrhage conversion, baseline NIHSS score, discharge NIHSS score, and modified Rankin Scale (mRS) score than those in the no-END group, whereas pre- and post-thrombolysis SIR levels were lower than those in the no-END group (P<0.05). Multifactorial logistic regression analysis showed that baseline NIHSS score, post-thrombolytic hemorrhagic conversion, and pre-thrombolytic SIR were independent risk factors for the development of END in patients with acute cerebral infarction treated with intravenous thrombolysis. Receiver operating curve (ROC) analysis showed that the area under the curve (AUC) of END detected by the combination of baseline NIHSS score and pre-thrombolysis SIR level was 0.791 (95% CI: 0.712-0.870), with sensitivity and specificity of 60% and 88.9%, respectively, and P<0.001 (Figure 1), which was higher than that of END detected by the two measures alone (baseline NIHSS score: AUC 0.770, 95% CI: 0.691-0.849, p=0.000; pre-thrombolytic SIR: AUC 0.654, 95% CI: 0.556-0.752, p=0.005). Spearman's correlation analysis showed that pre-thrombolysis SIR level was negatively correlated with the level of mRS score and post-thrombolysis hemorrhagic conversion (r=-0.218, p=0.000; r=-0.166, p=0.038), whereas it was positively correlated with post-thrombolysis SIR level (r=0.408, p=0.000). Conclusions: SIR levels can be used as a simple, non-invasive and highly reproducible method in combination with baseline NIHSS scores to determine the occurrence of END after intravenous thrombolysis, providing a method for early screening of individuals at risk for END.