Comparison of CT angiography collaterals for predicting target perfusion profile and clinical outcome in patients with acute ischemic stroke
To compare collateral status on single-phase CT angiography (sCTA) and multiphase CT angiography (mCTA) and their ability to predict a target mismatch on CT perfusion (CTP) and clinical outcome in patients with acute ischemic stroke (AIS).
Seventy-three AIS patients with stroke onset between 5 and 15 h or with unclear onset time and occlusions in the M1/M2 segment of the middle cerebral artery and/or intracranial internal carotid artery underwent head non-contrast CT and CTP. Simulated sCTA and mCTA were reconstructed from CTP data and were compared for collaterals assessment. The ability to predict target mismatch on CTP (an ischemic core < 70 ml, a mismatch ratio ≥ 1.8, and an absolute difference ≥ 15 ml) and 90-day modified Rankin Scale (mRS) score of 0–2 was compared between sCTA and mCTA by using receiver operating curve analysis.
sCTA underestimated the collateral status when compared with mCTA (p < 0.01). The ability of mCTA to predict target mismatch (AUC = 0.902, 95% confidence interval [CI] 0.809, 0.959) and clinical outcome (AUC = 0.771; 95% CI, 0.655, 0.864) was better than that of sCTA (p < 0.05 overall). A mCTA collateral score of > 3 best identified the target mismatch (sensitivity, 78.4%; specificity, 90.9%) and predicted 90-day mRS score of 0–2 (sensitivity, 84.8%; specificity, 69.4%).
The collaterals were better estimated by mCTA compared with sCTA. A mCTA collateral score of > 3 optimized the prediction of a target mismatch on CTP and a good clinical outcome in patients with AIS.
• Collateral circulation is a key determinant of ischemic core and penumbra. Better collaterals are associated with smaller ischemic core volumes and larger mismatch ratios on CT perfusion.
• The collaterals can be better estimated by multiphase CTA compared with single-phase CTA.
• A collateral score of > 3 on multiphase CTA best identifies patients with target mismatch on CT perfusion and predicts 90-day mRS score of 0–2.
KeywordsCollateral circulation Perfusion imaging CT angiography Stroke
Arterial input function
Acute ischemic stroke
Area under the ROC curve
Cerebral blood flow
Internal carotid artery
Interventional Management of Stroke
Middle cerebral artery (MCA)
Multiphase CT angiography
National Institute of Health Stroke Scale
Randomized controlled trials
Receiver operating characteristic
Single-phase CT angiography
Time to maximum
Venous input function
Volume perfusion CT
We sincerely thank Mrs. Min-lin Zhou from the National Clinical Research Center of Kidney Diseases, Jinling Hospital, for her reviewing of all the statistics. We also thank Dr. Kai Qiu and Dr. Wei Wang for their kind help in collecting the clinical information.
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Dr. Hai-bin Shi.
Email address: firstname.lastname@example.org.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
Mrs. Min-lin Zhou from national clinical research center of kidney diseases, Jinling Hospital, kindly provided statistical advice for this manuscript.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• Case-control study
• Performed at one institution