Objective To investigate the value of total cerebral small vessel disease （CSVD） score combined with three-dimensional arterial spin labeling （3D-ASL） in predicting the prognosis of patients with acute ischemic stroke （AIS） after 90 days of intravenous thrombolysis. Methods A total of 189 AIS patients who were consecutively admitted to Department of Neurology， Changshu Hospital Affiliated to Nantong University， from January 2021 to June 2023 and underwent intravenous thrombolysis with alteplase were enrolled， and multimodal brain MRI was performed to assess total CSVD load and cerebral blood flow in the area of responsibility. A multivariate logistic regression analysis was used to identify the independent influencing factors for poor 90-day prognosis in AIS patients undergoing intravenous thrombolysis. The receiver operating characteristic （ROC） curve was used to investigate the value of total CSVD score and 3D-ASL used alone or in combination in predicting the prognosis of AIS. Results The multivariate regression analysis showed that diabetes （OR=3.601，95%CI 1.448‒8.954，P=0.006）， total CSVD score ≥3 points （OR=4.077， 95%CI 1.785‒9.313，P=0.001）， and baseline NIHSS score （for every 1-point increase：OR=1.167， 95%CI 1.061‒1.283， P=0.001） were independent risk factors for poor prognosis in AIS patients on day 90 after intravenous thrombolysis，while ASL hyperperfusion was an independent protective factor against poor prognosis （OR=0.16， 95%CI 0.050‒0.356，P=0.014）.The ROC curve analysis showed that the predictive model based on CSVD score and ASL perfusion had a C-value of 0.844 （95%CI 0.786‒0.902， P<0.05） and thus had the best predictive efficacy. Conclusion Total CSVD score combined with 3D-ASL can more comprehensively reflect the whole brain circulation network and has a better effect than each indicator alone in predicting the 90-day prognosis of AIS patients undergoing intravenous thrombolysis.

Objective　To explore the value of the overall burden of cerebral small vessel disease (CSVD) in AIS patients treated with intravenous thrombolysis and find the optimal population.Methods　We retrospectively included 188 AIS patients who received intravenous thrombolysis with rt-PA in the Department of Neurology,Changshu Second People’s Hospital from March 2016 to January 2020.The total CSVD load was assessed based on 3.0 MRI.Multivariate logistic regression was used to analyze the influencing factors associated with 90 d poor prognosis (mRS score≥3).The predictive value of the score in different groups of patients were compared by ROC curve.Results　Multivariate analysis showed:diabetes (OR=2.828,95%CI 1.009 to 7.924,P=0.048),smoking (OR=9.396,95%CI 2.690 to 32.823,P<0.001),atrial fibrillation (OR=8.160,95%CI 2.167 to 30.729,P=0.002),baseline NIHSS score (for each additional point:OR=1.379,95%CI 1.241 to 1.5320,P<0.001),total CSVD score ≥3 points (OR=5.448,95%CI 1.720 to 17.260,P=0.004) were independent risk factors for poor prognosis in AIS patients treated with intravenous thrombolysis.ROC curve analysis shows that when 8≤NIHSS≤15,the CSVD total load score has a better predictive effect (C=0.828).Conclusion　The total CSVD score≥3 points is an independent risk factor for the poor prognosis of patients with intravenous thrombolysis at 90 days.And the score had the highest predictive value for patients with moderate to severe stroke.

Objective:This study compares the magnetic resonance imaging (MRI) appearance of two types of breast tissue markers to investigate the appropriate clinical application of the markers.Methods:Breast MRI of 69 patients (78 masses) with breast tissue markers had been placed were analyzed retrospectively from November 2015 to August 2018 in our hospital. The sizes and shapes of breast tissue markers were assessed in axial fat-suppressed T2-weighted images, T1-weighted images and contrast-enhanced T1-weighed images.Results:The length of the coil nickel-free stainless steel markers were greater than ribbon titanium markers, with statistical difference in fat-suppressed T2-weighted images ( P=0.039). In contrast-enhanced T1-weighted images, all coil nickel-free stainless steel markers showed >6 mm diameter and round shape, and ribbon titanium markers showed >6 mm diameter ( n=20) or ≤6 mm diameter ( n=8), and round ( n=20), dot ( n=7) or band ( n=1) shapes. The categories of sizes and shapes in two types of breast tissue markers both had statistical significance ( P<0.001, P<0.001). Conclusions:Small breast lesions with breast tissue markers are not suitable for MRI evaluation. The artifact of ribbon titanium markers is smaller than coil nickel-free stainless steel markers, so they have less impact for lesions. The choice of the breast tissue markers and image evaluation methods should depend on the different clinical conditions.