RT Journal Article
SR Electronic
T1 Perfusion Collateral Index versus Hypoperfusion Intensity Ratio in Assessment of Collaterals in Patients with Acute Ischemic Stroke
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1249
OP 1255
DO 10.3174/ajnr.A8002
VO 44
IS 11
A1 Tsui, Brian
A1 Chen, Iris E.
A1 Nour, May
A1 Kihira, Shingo
A1 Tavakkol, Elham
A1 Polson, Jennifer
A1 Zhang, Haoyue
A1 Qiao, Joe
A1 Bahr-Hosseini, Mersedeh
A1 Arnold, Corey
A1 Tateshima, Satoshi
A1 Salamon, Noriko
A1 Villablanca, J. Pablo
A1 Colby, Geoffrey P.
A1 Jahan, Reza
A1 Duckwiler, Gary
A1 Saver, Jeffrey L.
A1 Liebeskind, David S.
A1 Nael, Kambiz
YR 2023
UL http://www.ajnr.org/content/44/11/1249.abstract
AB BACKGROUND AND PURPOSE: Perfusion-based collateral indices such as the perfusion collateral index and the hypoperfusion intensity ratio have shown promise in the assessment of collaterals in patients with acute ischemic stroke. We aimed to compare the diagnostic performance of the perfusion collateral index and the hypoperfusion intensity ratio in collateral assessment compared with angiographic collaterals and outcome measures, including final infarct volume, infarct growth, and functional independence.MATERIALS AND METHODS: Consecutive patients with acute ischemic stroke with anterior circulation proximal arterial occlusion who underwent endovascular thrombectomy and had pre- and posttreatment MRI were included. Using pretreatment MR perfusion, we calculated the perfusion collateral index and the hypoperfusion intensity ratio for each patient. The angiographic collaterals obtained from DSA were dichotomized to sufficient (American Society of Interventional and Therapeutic Neuroradiology [ASITN] scale 3–4) versus insufficient (ASITN scale 0–2). The association of collateral status determined by the perfusion collateral index and the hypoperfusion intensity ratio was assessed against angiographic collaterals and outcome measures.RESULTS: A total of 98 patients met the inclusion criteria. Perfusion collateral index values were significantly higher in patients with sufficient angiographic collaterals (P < .001), while there was no significant (P = .46) difference in hypoperfusion intensity ratio values. Among patients with good (mRS 0–2) versus poor (mRS 3–6) functional outcome, the perfusion collateral index of ≥ 62 was present in 72% versus 31% (P = .003), while the hypoperfusion intensity ratio of ≤0.4 was present in 69% versus 56% (P = .52). The perfusion collateral index and the hypoperfusion intensity ratio were both significantly predictive of final infarct volume, but only the perfusion collateral index was significantly (P = .03) associated with infarct growth.CONCLUSIONS: Results show that the perfusion collateral index outperforms the hypoperfusion intensity ratio in the assessment of collateral status, infarct growth, and determination of functional outcomes.AISacute ischemic strokeASITNAmerican Society of Interventional and Therapeutic NeuroradiologyAUCarea under the curveHIRhypoperfusion intensity ratioIQRinterquartile rangemTICImodified TICIPCIperfusion collateral indexROCreceiver operating characteristicTmaxtime-to-maximum