Abstract
Background and PurposeMulti-delay arterial spin-labeling (ASL) perfusion imaging has been used as a promising modality to evaluate cerebral perfusion. Our aim was to assess the association of leptomeningeal collateral perfusion scores based on ASL parameters with outcome of endovascular treatment in patients with acute ischemic stroke (AIS) in the middle cerebral artery (MCA) territory.Materials and MethodsASL data at 4 post-labeling delay (PLD) times (PLD = 1.5, 2, 2.5, 3 s) were acquired during routine clinical magnetic resonance examination on AIS patients prior to endovascular treatment. A 3-point scale of leptomeningeal collateral perfusion grade on 10 anatomic regions was determined based on arterial transit times (ATT), cerebral blood flow (CBF), and arterial cerebral blood volume (CBV), estimated by the multi-delay ASL protocol. Based on a 90-day modified Rankin Scale (mRS), the patients were dichotomized to moderate/good (mRS 03) and poor outcome (mRS 46) and the regional collateral flow scores were compared.ResultsFifty-five AIS patients with unilateral MCA stroke (mean 73.9514.82 years) including 23 males were enrolled. Compared with poor outcome patients, patients with moderate to good outcomes had a significantly higher leptomeningeal collateral perfusion scores on CBV (3.012.11 vs. 1.821.51, p=0.024) but no differences on scores on CBF (2.311.61 vs. 1.661.32, p=0.231) and ATT (2.672.33 vs. 3.423.37, p=0.593).ConclusionsHigher leptomeningeal collateral perfusion scores on CBV images by ASL may be a specific marker of clinical outcome after endovascular treatment in patients with acute MCA ischemic stroke. Further study with larger sample size is warranted.
Highlights
In acute ischemic stroke, the collateral circulation alleviates ischemic injury to tissue and may keep the tissue viable during a vulnerable but potentially salvageable state [1]
Higher leptomeningeal collateral perfusion scores on cerebral blood volume (CBV) images by arterial spin-labeling (ASL) may be a specific marker of clinical outcome after endovascular treatment in patients with acute middle cerebral artery (MCA) ischemic stroke
Image data were included in this study if: (1) the patient was diagnosed as acute middle cerebral artery (MCA) stroke; (2) baseline MRI was performed within 24 hours of symptom onset; (3) the multi-delay multi-parametric 3D threedimensional pseudo-continuous arterial spin-labeling (pCASL) perfusion imaging was acquired along with routine clinical MRI, and was performed prior to thrombolysis or endovascular treatment; (4) the absence of previous intracranial hemorrhage, brain surgery, or large territorial lesion
Summary
The collateral circulation alleviates ischemic injury to tissue and may keep the tissue viable during a vulnerable but potentially salvageable state (penumbra) [1]. Leptomeningeal collaterals are anastomotic vessels providing alternative routes and play an important role in maintaining the cerebral circulation during acute stroke and chronic hypoperfusion [2]. There are several existing studies using a number of imaging modalities and grading methods, to www.impactjournals.com/oncotarget evaluate leptomeningeal collaterals in acute stroke [4]. Conventional angiography remains the reference standard to measure collateral extent and vessel number, with alternative CT, MRI and transcranial Doppler (TCD) based techniques, yet there is no accepted standard or routine imaging technique to quantify the extent of collateral circulation [5]. Our aim was to assess the association of leptomeningeal collateral perfusion scores based on ASL parameters with outcome of endovascular treatment in patients with acute ischemic stroke (AIS) in the middle cerebral artery (MCA) territory
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