CT Perfusion collateral index in assessment of collaterals in acute ischemic stroke with delayed presentation: Comparison to single phase CTA

Nael, Kambiz; Sakai, Yu; Larson, Jonathon E.; Goldstein, Jared; Deutsch, Jacob; Awad, Ahmed J.; Pawha, Puneet; Aggarwal, Amit; Fifi, Johanna T; DeLeacy, Reade; Yaniv, Gal; Wintermark, Max; Liebeskind, David S; Shoirah, Hazem; Mocco, J

doi:10.1016/j.neurad.2021.11.002

Cited by 15 publications

(8 citation statements)

References 43 publications

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“…A study on MR perfusion-based collateral assessment suggests that an arterial time delay of 2–6 s best describes the moderately hypoperfused volume [ 17 ]. The follow-up study with CTP confirmed that an arterial time delay of 2–6 s was indicative of collateralization [ 39 ]. We could not reproduce this finding in our CTP-based study as the volume of brain tissue with a Tmax of 2–6 s, although showing the expected trend, was not significantly associated with either the CTA collateral score nor the ordinal mRS in our patient population.…”

Section: Discussionmentioning

confidence: 99%

Value of CT Perfusion for Collateral Status Assessment in Patients with Acute Ischemic Stroke

Prasetya

Tolhuisen²,

Koopman³

et al. 2022

Diagnostics

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Good collateral status in acute ischemic stroke patients is an important indicator for good outcomes. Perfusion imaging potentially allows for the simultaneous assessment of local perfusion and collateral status. We combined multiple CTP parameters to evaluate a CTP-based collateral score. We included 85 patients with a baseline CTP and single-phase CTA images from the MR CLEAN Registry. We evaluated patients’ CTP parameters, including relative CBVs and tissue volumes with several time-to-maximum ranges, to be candidates for a CTP-based collateral score. The score candidate with the strongest association with CTA-based collateral score and a 90-day mRS was included for further analyses. We assessed the association of the CTP-based collateral score with the functional outcome (mRS 0–2) by analyzing three regression models: baseline prognostic factors (model 1), model 1 including the CTA-based collateral score (model 2), and model 1 including the CTP-based collateral score (model 3). The model performance was evaluated using C-statistic. Among the CTP-based collateral score candidates, relative CBVs with a time-to-maximum of 6–10 s showed a significant association with CTA-based collateral scores (p = 0.02) and mRS (p = 0.05) and was therefore selected for further analysis. Model 3 most accurately predicted favorable outcomes (C-statistic = 0.86, 95% CI: 0.77–0.94) although differences between regression models were not statistically significant. We introduced a CTP-based collateral score, which is significantly associated with functional outcome and may serve as an alternative collateral measure in settings where MR imaging is not feasible.

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Section: Discussionmentioning

confidence: 99%

Value of CT Perfusion for Collateral Status Assessment in Patients with Acute Ischemic Stroke

Prasetya

Tolhuisen²,

Koopman³

et al. 2022

Diagnostics

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“…The collateral index was calculated by dividing the volume of delay time > 6 s by the volume of delay time > 2 s ( 16 ). The mTICI score classified the degree of reperfusion ( 17 ), and a score of 2b−3 after the EVT procedure was considered a successful recanalization ( 19 ).…”

Section: Methodsmentioning

confidence: 99%

Large mismatch profile predicts rapidly progressing brain edema in acute anterior circulation large vessel occlusion patients undergoing endovascular thrombectomy

Shao

Chen²,

Wang³

et al. 2023

Front. Neurol.

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BackgroundBrain edema is a severe complication in patients with large vessel occlusion (LVO) that can reduce the effectiveness of endovascular therapy (EVT). This study aimed to investigate the association of the perfusion profile at baseline computed tomography (CT) perfusion with rapidly progressing brain edema (RPBE) after EVT in patients with acute anterior LVO.MethodsWe retrospectively reviewed consecutive data collected from 149 patients with anterior LVO who underwent EVT at our center. Brain edema was measured by the swelling score (0–6 score), and RPBE was defined as the swelling score increased by more than 2 scores within 24 h after EVT. We investigated the effect of RPBE on poor outcomes [National Institute of Health Stroke Scale (NIHSS) score and modified Rankin scale (mRS) score at discharge, the occurrence of hemorrhagic transformation, and mortality rate in the hospital] using the Mann–Whitney U-test and chi-square test. A multivariate logistic regression model was used to assess the relationship between perfusion imaging parameters and RPBE occurrence.ResultsOverall, 39 patients (26.2%) experienced RPBE after EVT. At discharge, RPBE was associated with higher NIHSS scores (Z = 3.52, 95% CI 2.0–12.0, P < 0.001) and higher mRS scores (Z = 3.67, 95% CI 0.0–1.0, P < 0.001) including the more frequent occurrence of hemorrhagic transformation (χ2 = 22.17, 95% CI 0.29–0.59, P < 0.001) and higher mortality rates in hospital (χ2 = 9.54, 95% CI 0.06–0.36, P = 0.002). Univariate analysis showed that intravenous thrombolysis, baseline ischemic core volume, and baseline mismatch ratio correlated with RPBE (all P < 0.05). After dividing the mismatch ratio into quartiles and performing a chi-square test between quartiles, we found that the occurrence of RPBE in Q4 (mismatch ratio > 11.3) was significantly lower than that in Q1 (mismatch ratio ≤ 3.0) (P < 0.05). The result of multivariate logistic regression analysis showed that compared with baseline mismatch ratio <5.1, baseline mismatch ratio between 5.1 and 11.3 (OR:3.85, 95% CI 1.06–14.29, P = 0.040), and mismatch ratio >11.3 (OR:5.26, 95% CI 1.28–20.00, P = 0.021) were independent protective factors for RPBE.ConclusionIn patients with anterior circulation LVO stroke undergoing successful EVT, a large mismatch ratio at baseline is a protective factor for RPBE, which is associated with poor outcomes.

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“…This technique was introduced by Smit et al [16]. It has been well-documented for collateral scoring [17][18][19][20], and a recent study by Nail et al, has confirmed its superiority in the assessment of collaterals compared to single phase CTA [21].…”

Section: Image Analysismentioning

confidence: 99%

Evolution of Hypodensity on Non-Contrast CT in Correlation with Collaterals in Anterior Circulation Stroke with Successful Endovascular Reperfusion

Gębka

Bajer-Czajkowska

Pyza

et al. 2022

JCM

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Introduction: The aim of the study was to assess the impact of collaterals on the evolution of hypodensity on non-contrast CT (NCCT) in anterior circulation stroke with reperfusion by mechanical thrombectomy (MT). Methods: We retrospectively included stroke patients with middle cerebral artery occlusion who were reperfused by MT in early and late time window. Artificial intelligence (AI)-based software was used to calculate of hypodensity volumes at baseline NCCT (V1) and at follow-up NCCT 24 h after MT (V2), along with the difference between the two volumes (V2-V1) and the follow-up (V2)/baseline (V1) volume ratio (V2/V1). The same software was used to classify collateral status by using a 4-point scale where the score of zero indicated no collaterals and the score of three represented contrast filling of all collaterals. The volumetric values were correlated with the collateral scores. Results: Collateral scores had significant negative correlation with V1 (p = 0.035), V2, V2− V1 and V2/V1 (p < 0.001). In cases with collateral score = 3, V2 was significantly smaller or absent compared to V1; in those with collateral score 2, V2 was slightly larger than V1, and in those with scores 1 and 0 V2 was significantly larger than V1. These relationships were observed in both early and late time windows. Conclusions: The collateral status determined the evolution of the baseline hypodensity on NCCT in patients with anterior circulation stroke who had MT reperfusion. Damage can be stable or reversible in patients with good collaterals while in those with poor collaterals tissues that initially appear normal will frequently appear as necrotic after 24 h. With good collaterals, it is stable or can be reversible while with poor collaterals, normal looking tissue frequently appears as necrotic in follow-up exam. Hence, acute hypodensity represents different states of the ischemic brain parenchyma.

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CT Perfusion collateral index in assessment of collaterals in acute ischemic stroke with delayed presentation: Comparison to single phase CTA

Cited by 15 publications

References 43 publications

Value of CT Perfusion for Collateral Status Assessment in Patients with Acute Ischemic Stroke

Value of CT Perfusion for Collateral Status Assessment in Patients with Acute Ischemic Stroke

Large mismatch profile predicts rapidly progressing brain edema in acute anterior circulation large vessel occlusion patients undergoing endovascular thrombectomy

Evolution of Hypodensity on Non-Contrast CT in Correlation with Collaterals in Anterior Circulation Stroke with Successful Endovascular Reperfusion

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