MRI-DWI sequence parameters and FLAIR sequences characteristics can predict acute stroke combined with cerebral edema

ZHAO Junhao; YANG Shu

doi:10.12122/j.issn.1674-4500.2025.12.13

Abstract：Objective To explore the predictive value of magnetic resonance-diffusion weighted imaging(MRI-DWI)and fluid-attenuated inversion recovery(FLAIR)sequences in acute stroke combined with cerebral edema.Methods A total of 150 patients with acute stroke admitted to the First People's Hospital of Guangyuan were retrospectively enrolled from June 2020 to June 2025.According to presence or absence of cerebral edema,they were divided into simple acute stroke group(non-combination group,92 cases)and cerebral edema group(combination group,58 cases).All patients underwent cranial MRI examinations within 24 h after admission,including T1WI,T2WI,DWI and FLAIR sequences.The apparent diffusion coefficient(ADC)and lesions volume in DWI sequence,signal intensity ratio(SIR)of lesion-normal brain tissue in FLAIR sequence and grading of FLAIR vascular hyperintensity(FVH)were obtained.The differences in the above imaging indexes and clinical data between the two groups were compared.The independent risk factors of acute stroke combined with cerebral edema were analyzed by multivariate Logistic regression analysis.The predictive efficiency of single index and combined detection for cerebral edema was evaluated by ROC curves.Results There were significant differences in age,NIHSS score at admission,interval from onset to admission and stroke types between non-combination group and combination group(P<0.05).ADC in non-combination group was greater than that in combination group,lesion volume on DWI,SIR and proportion of FVH grading at grade 2-3 were lower than those in non-combination group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that increased NIHSS score at admission,lesion volume on DWI and SIR,FVH grading at grade 2-3 and decreased ADC were all independent risk factors of acute stroke combined with cerebral edema(P<0.05).The results of ROC curves analysis showed that area under the curve(AUC)values of ADC,lesion volume on DWI,SIR,FVH grading and combined detection for predicting cerebral edema were 0.728(95%CI:0.648-0.808),0.741(95%CI:.0.656-0.826),0.714(95%CI:0.624-0.804),0.704(95%CI:0.632-0.777)and 0.837(95%CI:0.770-0.904),respectively(P<0.05).Conclusion MRI-DWI sequence parameters(ADC,lesion volume)and FLAIR sequence characteristics(SIR,FVH grading)are all independent high-risk factors of cerebral edema after acute stroke,which have significant predictive value in cerebral edema.