Quantitative insights into stroke recovery utilizing delayed vessel ratio from color-coded multiphase computed...

Area of Science:

• Neuroradiology
• Medical Imaging Analysis
• Stroke Research

Background:

• Acute ischemic stroke (AIS) involves large vessel occlusion, necessitating assessment of collateral blood flow.
• Color-coded multiphase computed tomography angiography (cmCTA) visualizes temporal dynamics of collateral circulation.
• Current methods often lack quantitative assessment of arterial and venous collaterals.

Purpose of the Study:

• To quantitatively assess arterial and venous collateral flow using cmCTA in AIS patients.
• To evaluate the predictive capability of cmCTA parameters for functional outcomes in AIS.
• To explore cmCTA's role in refining stroke assessment and treatment decisions.

Main Methods:

• Retrospective analysis of AIS patients with large vessel occlusion undergoing cmCTA.
• Calculation of collateral ratio and delayed vessel ratio (DVR) for arterial collaterals.
• Assessment of deep venous outflow (DVO) and superficial venous outflow (SVO) scores for venous collaterals.
• Logistic regression and propensity score analysis for outcome prediction.

Main Results:

• Well-developed arterial collaterals (low DVR) and adequate venous collaterals (high DVO/SVO) correlated with better functional outcomes (p < 0.001).
• Adjusted DVR demonstrated strong predictive performance (AUC 0.81-0.90) for functional independence and excellent recovery.
• Adjusted DVO also showed high predictive accuracy (AUC 0.88) for functional independence and excellent recovery.
• Prediction models exhibited good precision and net benefit.

Conclusions:

• cmCTA provides quantitative metrics (DVR, DVO, SVO) for collateral assessment in AIS.
• These quantitative measures offer an advantage over conventional grayscale CT imaging (e.g., ASPECT score).
• cmCTA-derived parameters can enhance pre-treatment collateral evaluation and post-treatment outcome prediction in AIS, aiding clinical decision-making.