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Subtracted Dynamic MR Perfusion Source Images (sMRP-SI) provide Collateral Blood Flow Assessment in MCA Occlusions
Kersten Villringer1, Rafael Serrano-Sandoval2, Ulrike Grittner3,4
1Academic Neuroradiology, Center for Stroke Research (CSB), Charité-Universitätsmedizin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany. kersten.villringer@charite.de.
Objectives:
Collateral blood flow is accepted as a predictive factor of tissue fate in ischemic stroke. Thus, we aimed to evaluate a new method derived from MR perfusion source images to assess collateral flow in patients with ICA/MCA occlusions.
Methods:
A total of 132 patients of the prospective 1000+ study were examined. MR perfusion source images were assessed according to Δimg_n = img_n + 1 - img_n - 1 using the five-grade Higashida collateral flow rating system. Higashida scores were correlated to mismatch (MM) volume, mismatch ratio, day 6 FLAIR lesion volumes and day 90 mRS.
Results:
Patients with Higashida scores 3 and 4 had significantly lower admission NIHSS, smaller FLAIR day 6 lesion volumes (p < 0.001) and higher rates of better long-term outcome (mRS 0-2, p = 0.002). There was a linear trend for the association of Higashida grade 1 (p = 0.002) and 2 (p = 0.001) with unfavourable outcome (day 90 mRS 3-6), but no significant association was found for MM volume, MM ratio and day 90 mRS. Inter-rater agreement was 0.58 (95% CI 0.43-0.73) on day 1, 0.70 (95% CI 0.58-0.81) on day 2.
Conclusion:
sMRP-SI Higashida score offers a non-invasive collateral vessel and tissue perfusion assessment of ischemic tissue. The predictive value of Higashida rating proved superior to MM with regard to day 90 mRS.
Key Points:
• Assessment of collateral flow using subtracted dynamic MR perfusion source imaging (sMRP-SI). • sMRP-SI offers additional information about morphological characteristics of ischemic brain tissue. • sMRP-SI collateral flow assessment proves superior to mismatch volume. • Better collateral flow was significantly associated with better outcome (day 90 mRS).
Insights
Subtracted dynamic MR perfusion source imaging (sMRP-SI) effectively assesses collateral blood flow in ischemic stroke patients. This method, using the Higashida score, predicts patient outcomes better than mismatch volume.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Collateral blood flow is a key predictor of tissue survival in ischemic stroke.
- Assessing collateral circulation is crucial for determining stroke prognosis and guiding treatment.
Purpose of the Study:
- To evaluate a novel method using MR perfusion source images (sMRP-SI) to assess collateral flow in patients with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusions.
- To compare the predictive value of the Higashida collateral flow rating system with traditional mismatch (MM) parameters.
Main Methods:
- 132 patients from the prospective 1000+ study were analyzed.
- MR perfusion source images were assessed using the five-grade Higashida collateral flow rating system.
- Higashida scores were correlated with mismatch volume, mismatch ratio, FLAIR lesion volumes, and day 90 modified Rankin Scale (mRS) scores.
Main Results:
- Higher Higashida scores (3 and 4) were associated with lower admission NIHSS, smaller day 6 FLAIR lesion volumes (p<0.001), and better long-term outcomes (mRS 0-2, p=0.002).
- Lower Higashida grades (1 and 2) showed a trend towards unfavorable outcomes (day 90 mRS 3-6).
- The Higashida score demonstrated superior predictive value for day 90 mRS compared to mismatch volume and ratio.
Conclusions:
- The sMRP-SI Higashida score provides a non-invasive assessment of collateral vessels and tissue perfusion in ischemic stroke.
- This method offers valuable information on the morphological characteristics of ischemic brain tissue.
- sMRP-SI collateral flow assessment is superior to mismatch volume in predicting patient outcomes.
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