Valente Michael, Bivard Andrew, Yan Bernard, Chen Chushuang, Visser Milanka, Ma Henry, Lin Longting, Parsons Mark
Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (M. Valente, A.B., B.Y., M. Visser).
Department of Neurology, Monash Health, Clayton, Victoria, Australia (M. Valente, H.M.).
Stroke. 2025 Feb;56(2):488-493. doi: 10.1161/STROKEAHA.124.048892. Epub 2025 Jan 6.
Vascular territory mapping (VTM) software estimates which intracerebral vessel provides predominant arterial flow to a brain voxel. The presence of antegrade flow in the setting of acute middle cerebral artery (MCA) occlusion is associated with improved outcomes. We identify whether VTM software is a determinant of antegrade flow in patients with proximal MCA occlusion.
Consecutive patients with the first branch of MCA (M1) occlusion were analyzed from the International Stroke Perfusion Imaging Registry with their computed tomography perfusion reprocessed through VTM software. Authors reviewed dynamic 4-dimensional computed tomography angiography for the presence of an acute M1 thrombus and also for the presence of residual antegrade flow. The VTM software assigned regions of the brain to an estimated feeding vessel (anterior cerebral artery, MCA, and posterior cerebral artery). A binomial logistic regression was performed to determine the effects of VTM, ischemic core (cerebral blood flow <30), and perfusion lesion (delay time >3) on the likelihood that patients had the presence of any antegrade flow in the MCA territory. A secondary analysis was performed to assess the relationship between imaging variables and 3-month modified Rankin Scale outcomes.
The final data set included 130 patients with M1 occlusion. The median age of participants was 74 years (interquartile range, 62-81) with an onset-to-scan time of 2.1 hours (interquartile range, 1.4-3.8) and a National Institutes of Health Stroke Scale score of 15 (interquartile range, 12-20). Eighteen patients were identified with antegrade flow on 4-dimensional digital subtraction angiography. Patients with antegrade flow had significantly larger VTM volume normal side MCA, 101 (72-180) mL, compared with those with complete occlusion, 41 (21-71) mL. VTM volume normal side MCA volume significantly predicted antegrade flow and outcome, and 1 mL VTM volume normal side MCA volume increased odds of antegrade flow by 1.024 (95% CI, 1.013-1.036). Ischemic core and the perfusion lesion volumes did not predict antegrade flow.
VTM software was more effective than traditional perfusion parameters in the detection of antegrade flow. The results demonstrate a potential clinical utility for VTM; however, larger cohorts will be required to detect whether VTM can predict clinical outcome after reperfusion treatment.
血管区域映射（VTM）软件可估计哪条脑内血管为脑内某一体素提供主要动脉血流。急性大脑中动脉（MCA）闭塞时存在顺行血流与预后改善相关。我们确定VTM软件是否是近端MCA闭塞患者顺行血流的决定因素。
对国际卒中灌注成像登记处中连续的MCA第一分支（M1）闭塞患者进行分析，其计算机断层扫描灌注图像通过VTM软件进行重新处理。作者回顾动态四维计算机断层血管造影，以确定是否存在急性M1血栓以及是否存在残余顺行血流。VTM软件将脑区分配给估计的供血血管（大脑前动脉、MCA和大脑后动脉）。进行二项逻辑回归以确定VTM、缺血核心区（脑血流量<30）和灌注损伤（延迟时间>3）对MCA区域存在任何顺行血流可能性的影响。进行二次分析以评估影像变量与3个月改良Rankin量表结局之间的关系。
最终数据集包括130例M1闭塞患者。参与者的中位年龄为74岁（四分位间距，62 - 81岁），发病至扫描时间为2.1小时（四分位间距，1.4 - 3.8小时），美国国立卫生研究院卒中量表评分为15分（四分位间距，12 - 20分）。18例患者在四维数字减影血管造影上被确定存在顺行血流。存在顺行血流的患者VTM正常侧MCA体积显著更大，为101（72 - 180）mL，而完全闭塞患者为41（21 - 71）mL。VTM正常侧MCA体积显著预测了顺行血流和结局，VTM正常侧MCA体积每增加1 mL，顺行血流的几率增加1.024（95%可信区间，1.013 - 1.036）。缺血核心区和灌注损伤体积不能预测顺行血流。
VTM软件在检测顺行血流方面比传统灌注参数更有效。结果表明VTM具有潜在的临床应用价值；然而，需要更大规模的队列研究来确定VTM是否能预测再灌注治疗后的临床结局。
