Kersten Villringer1, Rafael Serrano-Sandoval2, Ulrike Grittner3,4, Ivana Galinovic2, Alice Schneider3, Ann-Christin Ostwaldt2, Peter Brunecker2, Andrea Rocco5, Jochen B Fiebach2. 1. Academic Neuroradiology, Center for Stroke Research (CSB), Charité-Universitätsmedizin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany. kersten.villringer@charite.de. 2. Academic Neuroradiology, Center for Stroke Research (CSB), Charité-Universitätsmedizin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany. 3. Center for Stroke Research, Charité, Universitätsmedizin Berlin, Berlin, Germany. 4. Department for Biostatistics and Clinical Epidemiology, Charité, Berlin, Germany. 5. Department of Neurology and Center for Stroke Research, Charité, Berlin, Germany.
Abstract
OBJECTIVES: Collateral blood flow is accepted as a predictive factor of tissue fate in ischemic stroke. Thus, we aimed to evaluate a new method derived from MR perfusion source images to assess collateral flow in patients with ICA/MCA occlusions. METHODS: A total of 132 patients of the prospective 1000+ study were examined. MR perfusion source images were assessed according to Δimg_n = img_n + 1 - img_n - 1 using the five-grade Higashida collateral flow rating system. Higashida scores were correlated to mismatch (MM) volume, mismatch ratio, day 6 FLAIR lesion volumes and day 90 mRS. RESULTS: Patients with Higashida scores 3 and 4 had significantly lower admission NIHSS, smaller FLAIR day 6 lesion volumes (p < 0.001) and higher rates of better long-term outcome (mRS 0-2, p = 0.002). There was a linear trend for the association of Higashida grade 1 (p = 0.002) and 2 (p = 0.001) with unfavourable outcome (day 90 mRS 3-6), but no significant association was found for MM volume, MM ratio and day 90 mRS. Inter-rater agreement was 0.58 (95% CI 0.43-0.73) on day 1, 0.70 (95% CI 0.58-0.81) on day 2. CONCLUSION: sMRP-SI Higashida score offers a non-invasive collateral vessel and tissue perfusion assessment of ischemic tissue. The predictive value of Higashida rating proved superior to MM with regard to day 90 mRS. KEY POINTS: • Assessment of collateral flow using subtracted dynamic MR perfusion source imaging (sMRP-SI). • sMRP-SI offers additional information about morphological characteristics of ischemic brain tissue. • sMRP-SI collateral flow assessment proves superior to mismatch volume. • Better collateral flow was significantly associated with better outcome (day 90 mRS).
OBJECTIVES: Collateral blood flow is accepted as a predictive factor of tissue fate in ischemic stroke. Thus, we aimed to evaluate a new method derived from MR perfusion source images to assess collateral flow in patients with ICA/MCA occlusions. METHODS: A total of 132 patients of the prospective 1000+ study were examined. MR perfusion source images were assessed according to Δimg_n = img_n + 1 - img_n - 1 using the five-grade Higashida collateral flow rating system. Higashida scores were correlated to mismatch (MM) volume, mismatch ratio, day 6 FLAIR lesion volumes and day 90 mRS. RESULTS:Patients with Higashida scores 3 and 4 had significantly lower admission NIHSS, smaller FLAIR day 6 lesion volumes (p < 0.001) and higher rates of better long-term outcome (mRS 0-2, p = 0.002). There was a linear trend for the association of Higashida grade 1 (p = 0.002) and 2 (p = 0.001) with unfavourable outcome (day 90 mRS 3-6), but no significant association was found for MM volume, MM ratio and day 90 mRS. Inter-rater agreement was 0.58 (95% CI 0.43-0.73) on day 1, 0.70 (95% CI 0.58-0.81) on day 2. CONCLUSION:sMRP-SI Higashida score offers a non-invasive collateral vessel and tissue perfusion assessment of ischemic tissue. The predictive value of Higashida rating proved superior to MM with regard to day 90 mRS. KEY POINTS: • Assessment of collateral flow using subtracted dynamic MR perfusion source imaging (sMRP-SI). • sMRP-SI offers additional information about morphological characteristics of ischemic brain tissue. • sMRP-SI collateral flow assessment proves superior to mismatch volume. • Better collateral flow was significantly associated with better outcome (day 90 mRS).
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