TY - JOUR
T1 - Value of CT Perfusion for Collateral Status Assessment in Patients with Acute Ischemic Stroke
AU - Prasetya, Haryadi
AU - Tolhuisen, Manon L
AU - Koopman, Miou S
AU - Kappelhof, Manon
AU - Meijer, Frederick J A
AU - Yo, Lonneke S F
AU - Á Nijeholt, Geert J Lycklama
AU - van Zwam, Wim H
AU - van der Lugt, Aad
AU - Roos, Yvo B W E M
AU - Majoie, Charles B L M
AU - van Bavel, Ed T
AU - Marquering, Henk A
AU - On Behalf Of The Mr Clean Registry Investigators, null
N1 - Funding Information:
van der Lugt is the recipient of unrestricted grants from the Dutch Heart Foundation, the Dutch Brain Foundation, the Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Science, Stryker, Medtronic, Penumbra Inc., and Cerenovus for the conduct of trials regarding acute treatments for stroke. van Zwam received speaker fees from Stryker, Nicolab, and Cerenovus, and consultation fees from Philips (all paid to the institution). Roos is a shareholder of Nicolab. Majoie reports grants from CVON/the Dutch Heart Foundation, the TWIN Foundation, the European Commission, the Dutch Health Evaluation program, and Stryker outside of the submitted work (paid to the institution) and is a shareholder of Nicolab. Marquering is cofounder and shareholder of Nicolab. The funder had no role in the design of the study; in the collection, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
Funding Information:
This research was funded by the Indonesia Endowment Fund for Education (LPDP), Ministry of Finance, Republic of Indonesia through the LPDP scholarship Program for Doctorate Students.
Publisher Copyright:
© 2022 by the authors.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - Good collateral status in acute ischemic stroke patients is an important indicator for good outcomes. Perfusion imaging potentially allows for the simultaneous assessment of local perfusion and collateral status. We combined multiple CTP parameters to evaluate a CTP-based collateral score. We included 85 patients with a baseline CTP and single-phase CTA images from the MR CLEAN Registry. We evaluated patients' CTP parameters, including relative CBVs and tissue volumes with several time-to-maximum ranges, to be candidates for a CTP-based collateral score. The score candidate with the strongest association with CTA-based collateral score and a 90-day mRS was included for further analyses. We assessed the association of the CTP-based collateral score with the functional outcome (mRS 0-2) by analyzing three regression models: baseline prognostic factors (model 1), model 1 including the CTA-based collateral score (model 2), and model 1 including the CTP-based collateral score (model 3). The model performance was evaluated using C-statistic. Among the CTP-based collateral score candidates, relative CBVs with a time-to-maximum of 6-10 s showed a significant association with CTA-based collateral scores (p = 0.02) and mRS (p = 0.05) and was therefore selected for further analysis. Model 3 most accurately predicted favorable outcomes (C-statistic = 0.86, 95% CI: 0.77-0.94) although differences between regression models were not statistically significant. We introduced a CTP-based collateral score, which is significantly associated with functional outcome and may serve as an alternative collateral measure in settings where MR imaging is not feasible.
AB - Good collateral status in acute ischemic stroke patients is an important indicator for good outcomes. Perfusion imaging potentially allows for the simultaneous assessment of local perfusion and collateral status. We combined multiple CTP parameters to evaluate a CTP-based collateral score. We included 85 patients with a baseline CTP and single-phase CTA images from the MR CLEAN Registry. We evaluated patients' CTP parameters, including relative CBVs and tissue volumes with several time-to-maximum ranges, to be candidates for a CTP-based collateral score. The score candidate with the strongest association with CTA-based collateral score and a 90-day mRS was included for further analyses. We assessed the association of the CTP-based collateral score with the functional outcome (mRS 0-2) by analyzing three regression models: baseline prognostic factors (model 1), model 1 including the CTA-based collateral score (model 2), and model 1 including the CTP-based collateral score (model 3). The model performance was evaluated using C-statistic. Among the CTP-based collateral score candidates, relative CBVs with a time-to-maximum of 6-10 s showed a significant association with CTA-based collateral scores (p = 0.02) and mRS (p = 0.05) and was therefore selected for further analysis. Model 3 most accurately predicted favorable outcomes (C-statistic = 0.86, 95% CI: 0.77-0.94) although differences between regression models were not statistically significant. We introduced a CTP-based collateral score, which is significantly associated with functional outcome and may serve as an alternative collateral measure in settings where MR imaging is not feasible.
U2 - 10.3390/diagnostics12123014
DO - 10.3390/diagnostics12123014
M3 - Article
C2 - 36553021
SN - 2075-4418
VL - 12
JO - Diagnostics
JF - Diagnostics
IS - 12
M1 - 3014
ER -