Abstract
Background: This study was to evaluate the correlation of the hypoperfusion intensity ratio (HIR) with the collateral score from multiphase computed tomography angiography (mCTA) among patients with large vessel stroke. Method: From February 2019 to May 2020, we retrospectively reviewed the patients with large vessel strokes (intracranial carotid artery or proximal middle cerebral artery occlusion). HIR was defined as a Tmax > 10 s lesion volume divided by a Tmax > 6 s lesion volume, which was calculated by automatic software (Syngo.via, Siemens). The correlation between the HIR and mCTA score was evaluated by Pearson’s correlation. The cutoff value predicting the mCTA score was evaluated by receiver operating characteristic analysis. Result: Ninety-four patients were enrolled in the final analysis. The patients with good collaterals had a smaller core volume (37.3 ± 24.7 vs. 116.5 ± 70 mL, p < 0.001) and lower HIR (0.51 ± 0.2 vs. 0.73 ± 0.13, p < 0.001) than those with poor collaterals. A higher HIR was correlated with a poorer collateral score by Pearson’s correlation. (r = −0.64, p < 0.001). The receiver operating characteristic (ROC) analysis suggested that the best HIR value for predicting a good collateral score was 0.68 (area under curve: 0.82). Conclusion: HIR is a good surrogate of collateral circulation in patients with acute large artery occlusion.
Highlights
Evaluating pial collateral status is of great importance in predicting the evolution of infarction [1], predicting the prognosis of acute ischemic stroke [2], and selecting eligible patients for endovascular thrombectomy (EVT) [3]
After excluding those without large vessel occlusion (LVO) (n = 153), those with stroke in the posterior circulation and posterior cerebral artery (PCA) territory (n = 56), those in the anterior cerebral artery (ACA) territory (n = 9), those with bilateral or multiple occlusion sites (n = 3) and those with poor image quality or missing data (n = 26), 94 patients were enrolled in the final analysis (Figure 1)
Our study found that the hypoperfusion intensity ratio (HIR) is correlated with the multiphase computed tomography angiography (mCTA) collateral score in patients with acute occlusions at the internal carotid artery (ICA), M1, or M2 segment of the middle cerebral artery (MCA), with 0.68 being the best value that predicts a good collateral score by Syngo.via CT Neuro Perfusion software
Summary
Evaluating pial (leptomeningeal) collateral status is of great importance in predicting the evolution of infarction [1], predicting the prognosis of acute ischemic stroke [2], and selecting eligible patients for endovascular thrombectomy (EVT) [3]. The development of automatic postprocessing software for CTP gives physicians more quantitative and rapid measures to evaluate the infarct core and potentially salvageable tissue. The HIR has been shown to predict the rate of infarct growth and functional outcome at 90 days after stroke in the DEFUSE 2 cohort; it is thought to be a clinical parameter that evaluates the degree of collateral circulation [8]. In another retrospective study, patients who met
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