Conventional enhancement CT: a valuable tool for evaluating pial collateral flow in acute ischemic stroke

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Evaluating pial collateral flow is crucial for acute ischemic stroke management.
• A rapid and easy method for assessing collateral circulation is needed.

Purpose of the Study:

• To compare the Alberta Stroke Program Early CT Score (ASPECTS) on nonenhanced CT (NECT), contrast-enhanced CT (CECT), and CT angiography source images (CTA-SI) for evaluating pial collateral flow in acute ischemic stroke.
• To determine the predictive value of ASPECTS on different CT modalities for patient outcomes.

Main Methods:

• Retrospective review of 55 anterior circulation acute ischemic stroke patients treated with thrombolysis.
• Assessment of pial collateral formation using NECT, CECT, and CTA-SI, graded against 4-vessel angiography.
• Patient outcomes assessed using the 90-day modified Rankin Scale (mRS).

Main Results:

• ASPECTS on CECT showed a stronger inverse correlation with pial collateral formation (r = -0.788) compared to NECT (r = -0.557) and CTA-SI (r = -0.662).
• ASPECTS on CECT demonstrated superior discriminative capability for fair collateral circulation (AUC = 0.885).
• ASPECTS on CECT (≥8) independently predicted fair collateral circulation (OR = 23.00) and good prognosis (OR = 17.81).

Conclusions:

• ASPECTS on CECT is a feasible and effective method for predicting pial collateral flow in acute ischemic stroke.
• CECT-based ASPECTS is a valuable tool for predicting overall patient outcomes in acute ischemic stroke.