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Updated: Aug 24, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Hypoperfusion intensity ratio and CBV index as predictive parameters to identify underlying intracranial
Yukihiro Imaoka1, Seigo Shindo2, Masatomo Miura2
1Department of Neurosurgery, Kumamoto Red Cross Hospital, 2-1-1 Nagamineminami, Higashiku, Kumamoto City, Kumamoto 861-8520, Japan; Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto City, Kumamoto 860-8556, Japan.
Insights
Hypoperfusion intensity ratio (HIR) and cerebral blood volume (CBV) index can predict intracranial atherosclerotic stenosis (ICAS) in patients with large vessel occlusion (LVO) undergoing endovascular thrombectomy (EVT). These imaging markers may aid in emergency diagnosis.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion (LVO) presents diagnostic challenges prior to endovascular thrombectomy (EVT).
- Effective collateral flow assessment is crucial for predicting underlying ICAS.
Purpose of the Study:
- To evaluate the utility of hypoperfusion intensity ratio (HIR) and cerebral blood volume (CBV) index in predicting ICAS in patients with LVO undergoing EVT.
- To assess the association between these perfusion parameters and underlying ICAS.
Main Methods:
- Retrospective review of clinical and perfusion imaging data from patients undergoing EVT for LVO.
- Patients categorized into ICAS and embolism groups based on angiography.
- Multivariable logistic regression and receiver operating characteristic (ROC) analyses to assess parameter association and discriminative ability.
Main Results:
- HIR (cutoff ≤ 0.22) demonstrated good discrimination (AUC 0.85) for ICAS.
- CBV index (cutoff ≥ 0.90) showed excellent discrimination (AUC 0.92) for ICAS.
- HIR ≤ 0.22 (OR 22.5) and CBV index ≥ 0.9 (OR 75.7) were significantly associated with underlying ICAS.
Conclusions:
- HIR ≤ 0.22 and CBV index ≥ 0.9 are valuable predictors of underlying ICAS.
- These perfusion parameters may assist in the pre-EVT diagnosis of ICAS in LVO patients.
Background And Purpose:
Intracranial atherosclerotic stenosis (ICAS)-related large vessel occlusion (LVO) is difficult to diagnose before endovascular thrombectomy (EVT) in an emergency. We hypothesized that hypoperfusion intensity ratio (HIR) and cerebral blood volume (CBV) index reflect collateral flow and would be useful parameters to predict underlying ICAS.
Materials And Methods:
Clinical and perfusion imaging parameters of patients receiving EVT for LVO were reviewed retrospectively. Patients were divided into ICAS and embolism groups with angiographical findings. The association between prespecified parameters and underlying ICAS were assessed using multivariable logistic regression analyses. Discriminative ability was assessed using receiver operating characteristic analysis.
Results:
Among 238 consecutive patients, 47 satisfied the inclusion criteria, including 10 with ICAS-related LVO. In ROC analyses, HIR showed good discrimination with a cutoff value of 0.22 (area under the curve, 0.85; 95%CI, 0.75-0.96; sensitivity, 0.84; specificity, 0.80) for underlying ICAS. CBV index showed excellent discrimination with a cutoff value of 0.90 (area under the curve, 0.92; 95%CI, 0.81-0.98; sensitivity, 0.92; specificity, 0.79). Multivariable logistic regression analysis revealed that HIR ≤ 0.22 (OR, 22.5; 95%CI, 2.9-177.0; P = 0.003) and CBV index ≥ 0.9 (OR, 75.7; 95%CI, 5.8-994.0; P < 0.001) were significantly associated with underlying ICAS.
Conclusion:
HIR ≤ 0.22 and CBV index ≥ 0.9 were associated with underlying ICAS and may predict underlying ICAS before EVT.
