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RAPID CT Perfusion-Based Relative CBF Identifies Good Collateral Status Better Than Hypoperfusion Intensity Ratio,

A Potreck1, E Scheidecker1, C S Weyland1

  • 1From the Departments of Neuroradiology (A.P., E.S., C.S.W., U.N., C.H., M.A.M., M.B., F.S.).

AJNR. American Journal of Neuroradiology
|June 9, 2022
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Summary

Assessing collateral flow in acute ischemic stroke is crucial for thrombectomy eligibility. Relative cerebral blood flow (CBF) < 38% is a strong indicator of good collateral status, outperforming other CT perfusion parameters.

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Collateral flow information is vital for determining thrombectomy eligibility in acute ischemic stroke patients.
  • Identifying reliable surrogate parameters for collateral status on CT perfusion imaging is essential.

Purpose of the Study:

  • To identify CT perfusion-based surrogate parameters indicative of good collateral status in acute anterior circulation ischemic stroke.
  • To correlate CT perfusion parameters with collateral scores derived from dynamic CTA.

Main Methods:

  • Retrospective analysis of 214 acute ischemic stroke patients with MCA M1 segment or carotid terminus occlusion.
  • Collateral status assessed on dynamic CTA using a multiphase CTA score.
  • CT perfusion parameters (time-to-maximum, relative CBF, hypoperfusion intensity ratio, CBV-index) analyzed with RAPID software.
  • Spearman correlation and ROC analyses to identify parameters correlating with collateral scores and good collateral supply (score ≥4).

Main Results:

  • Relative cerebral blood flow (CBF) < 38% volume showed the highest correlation with good collateral status (ρ = -0.66, P < .001).
  • Relative CBF < 38% at a lesion size <27 mL demonstrated superior performance in identifying good collateral status (sensitivity 75%, specificity 80%).
  • Other parameters like time-to-maximum, hypoperfusion intensity ratio, and CBV-index also correlated with collateral status but with lower accuracy.

Conclusions:

  • Automated CT perfusion analysis accurately identifies collateral status in acute ischemic stroke.
  • Relative CBF < 38% serves as a superior perfusion-based indicator of good collateral supply compared to other assessed CT perfusion parameters.