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Fractal-Based Quantitative Collateral Assessment for Thrombectomy Candidate Selection in Acute Ischemic Stroke: A
Chien-Hung Chang1,2, Chi-Ming Ku3, Tzong-Rong Ger3
1Department of Neurology, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan.
Diagnostics (Basel, Switzerland)
|July 12, 2025
Summary
A new multiphase quantitative collateral score (mqCS) shows promise for predicting outcomes after acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT). This objective imaging biomarker offers a more reliable assessment than visual collateral scoring (vCS).
Area of Science:
- Neuroimaging
- Cerebrovascular Diseases
- Medical Imaging Biomarkers
Background:
- Acute ischemic stroke (AIS) is a major global health concern, leading to significant mortality and disability.
- Assessing collateral circulation is crucial for predicting patient outcomes after endovascular thrombectomy (EVT).
- Current visual collateral scoring (vCS) methods are subjective and suffer from inter-observer variability.
Purpose of the Study:
- To introduce and evaluate the multiphase quantitative collateral score (mqCS), a novel imaging biomarker for objective collateral assessment in AIS.
- To compare the predictive value of mqCS against conventional vCS for functional outcomes following EVT.
- To explore the potential of mqCS in improving decision-making for EVT.
Main Methods:
- Retrospective analysis of 54 AIS patients who underwent EVT.
- Collateral status assessed using both vCS (by two blinded neuroradiologists) and mqCS derived from multiphase CT angiography (mCTA) using fractal dimension (FD) and delay indicator (DI) metrics.
- Logistic regression and receiver operating characteristic (ROC) analyses were used to evaluate predictive accuracy for favorable 90-day functional outcomes (modified Rankin scale, mRS ≤ 2).
Main Results:
- The mqCS demonstrated a significant association with favorable 90-day functional outcomes (adjusted OR = 5.98, AUC = 0.80).
- Patients with higher mqCS values (≥ 0.8674) had significantly better odds of favorable outcomes compared to vCS (adjusted OR = 2.84, AUC = 0.79).
- Patients in the highest mqCS quartiles showed significantly higher recovery rates (69%).
Conclusions:
- The mqCS offers a potentially more objective and reproducible method for collateral assessment in AIS compared to vCS.
- This novel biomarker enhances the prediction of functional outcomes after EVT, aiding in treatment decisions.
- Further validation in larger, prospective studies is warranted, with potential for integration into automated imaging platforms.
