Deep medullary veins as an important imaging indicator of poor prognosis in acute ischemic stroke: a retrospective cohort survey

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Background: The deep medullary veins (DMVs), which constitute a component of the intracerebral venous circulation system and are part of intracerebral reperfusion mechanisms, have been suggested as a novel imaging marker for cerebral white matter hypersignal and cerebral small vessel disease based on their discontinuous and reduced visual representation. However, the correlation between the number and continuity of visible DMVs and the poor prognosis of acute ischemic stroke (AIS) remains undefined. Magnetic susceptibility-weighted imaging was applied in this study to assess the distribution and structural characteristics of DMVs in patients with AIS and to investigate its relationship with the poor prognosis of those with AIS. Methods: This retrospective study included 90 patients diagnosed with AIS in the middle cerebral artery region by the Neurology Department of Liaoning Provincial People's Hospital. Clinical, laboratory, and cranial magnetic resonance imaging data were collected. After the 3-month follow-up visit, patients were dichotomized into good (0-2 points) and poor (≥3 points) prognosis groups based on the modified Rankin Scale score, and the DMV imaging characteristics were evaluated using a 3-level visual rating scale. The association between DMV and AIS prognosis was determined through Mann-Whitney test and multivariate logistic regression analysis. Results: In univariate analysis, factors that were statistically significant between the different prognostic groups were DMV score (P=0.007), DMV symmetry (P=0.016), infarct size (P=0.029), and admission National Institutes of Health Stroke Scale (NIHSS) score (P<0.001). DMV score had a positive correlation with NIHSS score, (rs=0.209; P=0.048). Logistic regression analysis showed that the DMV score [odds ratio (OR), 1.356; 95% confidence interval (CI): 1.114-1.650; P=0.002], NIHSS score (OR, 1.280; 95% CI: 1.117-1.466; P<0.001), and fasting glucose (OR, 1.220; 95% CI: 1.023-1.456; P=0.027) were risk factors for poor prognosis in those with AIS. Conclusions: Discontinuity in DMV visualization was found to be associated with an unfavorable prognosis for patients AIS. The visual assessment of DMV through susceptibility-weighted imaging has the potential to predict AIS prognosis and furnish valuable insights for clinical treatment.

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