Abstract
Objectives: To develop an efficient and quantitative assessment of collateral circulation on time maximum intensity projection CT angiography (tMIP CTA) in patients with acute ischemic stroke (AIS).Methods: Eighty-one AIS patients who underwent one-stop CTA-CT perfusion (CTP) from February 2016 to October 2020 were retrospectively reviewed. Single-phase CTA (sCTA) and tMIP CTA were developed from CTP data. Ischemic core (IC) volume, ischemic penumbra volume, and mismatch ratio were calculated. The Tan scale was used for the qualitative evaluation of collateral based on sCTA and tMIP CTA. Quantitative collateral circulation (CCq) parameters were calculated semi-automatically with software by the ratio of the vascular volume (V) on both hemispheres, including tMIP CTA VCCq and sCTA VCCq. Spearman correlation analysis was used to analyze the correlation of collateral-related parameters with final infarct volume (FIV). ROC and multivariable regression analysis were calculated to compare the significance of the above parameters in clinical outcome evaluation. The analysis time of the observers was also compared.Results: tMIP CTA VCCq (r = 0.61, p < 0.01), IC volume (r = 0.66, p < 0.01), Tan score on tMIP CTA (r = 0.52, p < 0.01) and mismatch ratio (r = 0.60, p < 0.01) showed moderate negative correlations with FIV. tMIP CTA VCCq showed the best prognostic value for clinical outcome (AUC = 0.93, p < 0.001), and was an independent predictive factor of clinical outcome (OR = 0.14, p = 0.009). There was no difference in analysis time of tMIP CTA VCCq among observers (p = 0.079).Conclusion: The quantitative evaluation of collateral circulation on tMIP CTA is associated with clinical outcomes in AIS patients with endovascular treatments.
Highlights
Reperfusion therapies significantly improve the prognosis of patients with acute ischemic stroke (AIS)
The quantitative evaluation of collateral circulation on temporally fused maximum intensity projection (tMIP) computed tomography angiography (CTA) is associated with clinical outcomes in AIS patients with endovascular treatments
Time maximum intensity projection angiography, known as timing-invariant (TI) CTA [10] or temporally fused maximum intensity projection CTA [7], reflects the maximum value on all projection planes scrolling over time, producing a new volume-based data packet that is generated from all phases images of CT perfusion (CTP). tMIP CTA may eliminate the drawback of single-phase CTA wherein collateral vessels are usually displayed incompletely due to delayed pathophysiology status, building a system with high temporal and spatial resolution [7, 8, 10,11,12]
Summary
Reperfusion therapies significantly improve the prognosis of patients with acute ischemic stroke (AIS). With the popularization of endovascular treatments (EVTs) in AIS, it is necessary to build an individualized evaluation system, helping physicians make clinical decisions and predict outcomes before invasive intervention [1, 2]. Comprehensive and accurate evaluation of collateral circulation is a necessary complement to develop individualized treatments for AIS patients. Because the interindividual collateral circulation (distribution, filling time, etc.) is highly variable and the optimal acquisition time is individually different, four-dimensional CTA (4D CTA) obtained from the perfusion data (multi-time frame) was applied to evaluate collateral status more accurately [7,8,9]. Time maximum intensity projection angiography (tMIP CTA), known as timing-invariant (TI) CTA [10] or temporally fused maximum intensity projection (tMIP) CTA [7], reflects the maximum value on all projection planes scrolling over time, producing a new volume-based data packet that is generated from all phases images of CT perfusion (CTP). TMIP CTA improves the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of images and may be an ideal option for assessing collateral circulation [7, 8, 12]
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