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Quantitative multi-slice spiral CT perfusion parameters as predictors of collateral status and 90-day functional
Dan Zhu1, Xiaozhou Ma1, Yingzhi Jiao1
1Imaging Center, Qianwei Hospital of Jilin Province, Changchun, Jilin, China.
Objective:
To evaluate the utility of quantitative computed tomography perfusion parameters for assessing collateral circulation and predicting 90-day functional outcomes in acute ischemic stroke.
Methods:
This retrospective study included 82 patients who underwent perfusion imaging within 24 h of symptom onset. Parameters including relative cerebral blood flow, relative cerebral blood volume, mean transit time, time to maximum, and hypoperfusion intensity ratio were analyzed. Collateral status was classified using multiphase angiography, and 90-day outcomes were assessed using the modified Rankin Scale.
Results:
Patients with robust collateral circulation showed higher relative cerebral blood flow and volume and shorter perfusion times compared with those with poor collaterals. Hypoperfusion intensity ratio demonstrated strong diagnostic performance (area under the curve 0.925). For predicting unfavorable 90-day outcome, HIR achieved an AUC of 0.912 and showed greater discrimination than mismatch ratio in the present cohort, while the combined HIR-rCBF-Tmax model achieved an AUC of 0.938. Hypoperfusion intensity ratio correlated positively with functional disability, while relative cerebral blood flow correlated negatively with infarct volume. Favorable outcomes were more frequent in patients with robust collaterals.
Conclusion:
Quantitative CTP parameters bridge a natomical collateral assessment and downstream tissue-level perfusion. HIR may provide a particularly informative functional marker of collateral efficiency and 90-day prognosis beyond conventional mismatch assessment.
