Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 90095, USA; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
J Neuroradiol. 2022 Mar;49(2):198-204. doi: 10.1016/j.neurad.2021.11.002. Epub 2021 Nov 17.
BACKGROUND & PURPOSE: Perfusion collateral index (PCI) has been recently defined as a promising measure of collateral status. We sought to compare collateral status assessed via CT-PCI in comparison to single-phase CTA and their relationship to outcome measures including final infarction volume, final recanalization status and functional outcome in ELVO patients.
ELVO patients with anterior circulation large vessel occlusion who had baseline CTA and CT perfusion and underwent endovascular treatment were included. Collateral status was assessed on CTA. PCI from CT perfusion was calculated in each patient and an optimal threshold to separate good vs insufficient collaterals was identified using DSA as reference. The collateral status determined by CTA and PCI were assessed against 3 measured outcomes: 1) final infarction volume; 2) final recanalization status defined by TICI scores; 3) functional outcome measured by 90-day mRS.
A total of 53 patients met inclusion criteria. Excellent recanalization defined by TICI ≥2C was achieved in 36 (68%) patients and 23 patients (43%) had good functional outcome (mRS ≤2). While having good collaterals on both CTA and CTP-PCI was associated with significantly (p<0.05) smaller final infarction volume, only good collaterals status determined by CTP-PCI was associated with achieving excellent recanalization (p = 0.001) and good functional outcome (p = 0.003).
CTP-based PCI outperforms CTA collateral scores in determination of excellent recanalization and good functional outcome and may be a promising imaging marker of collateral status in patients with delayed presentation of AIS.
灌注侧支指数（PCI）最近被定义为侧支状态的一种有前途的衡量标准。我们旨在比较通过 CT-PCI 评估的侧支状态与单相 CTA 的比较，并将其与包括最终梗死体积、最终再通状态和功能结局在内的结局测量指标相关联，这些结局测量指标在 ELVO 患者中进行评估。
纳入了前循环大血管闭塞且具有基线 CTA 和 CT 灌注并接受血管内治疗的 ELVO 患者。通过 CTA 评估侧支状态。在每个患者中计算 CT 灌注的 PCI，并使用 DSA 作为参考确定最佳阈值以区分良好和不足的侧支。通过 CTA 和 PCI 确定的侧支状态与 3 个测量结果进行评估：1）最终梗死体积；2）通过 TICI 评分定义的最终再通状态；3）通过 90 天 mRS 测量的功能结局。
共有 53 名患者符合纳入标准。36 名患者（68%）实现了极好的再通（TICI≥2C），23 名患者（43%）具有良好的功能结局（mRS≤2）。虽然 CTA 和 CTP-PCI 上的良好侧支均与明显较小的最终梗死体积相关（p<0.05），但仅 CTP-PCI 上的良好侧支状态与实现极好的再通（p=0.001）和良好的功能结局（p=0.003）相关。
基于 CTP 的 PCI 在确定极好的再通和良好的功能结局方面优于 CTA 侧支评分，并且可能是 AIS 延迟表现患者侧支状态的一种有前途的影像学标志物。
