One-stop multi-modality CT to assess collateral circulation and prognosis in acute ischemicstroke(PDF)
《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]
- Issue:
- 2025年第4期
- Page:
- 471-478
- Research Field:
- 医学影像物理
- Publishing date:
Info
- Title:
- One-stop multi-modality CT to assess collateral circulation and prognosis in acute ischemicstroke
- Author(s):
- LI Xuejiao; NIE Junyang; XIE Yicai; HUANG Junrong; SU Hongyan
- Department of Radiology, Wuzhou Red Cross Hospital, Wuzhou 543000, China
- Keywords:
- one-stop; multi-modality; computed tomography; acute ischemic stroke; collateral circulation
- PACS:
- R743.3；R816.1
- DOI:
- 10.3969/j.issn.1005-202X.2025.04.008
- Abstract:
- Objective To investigate the potential of one-stop multi-modality CT in the assessment of collateral circulationand prognosis in acute ischemic stroke (AIS). Methods From February 2022 to May 2024, 115 patients diagnosed with AISat Wuzhou Red Cross Hospital were enrolled in the study. All subjects were examined with one-stop multi-modality CT atadmission and received endovascular therapy. According to the collateral circulation score derived from multi-phase CTangiography (mCTA) and the modified Rankin scale score at 90 days, these patients were divided into different groups: good(n=59) vs poor (n=56) collateral circulation groups, and favorable (n=48) vs unfavorable (n=67) outcome groups. Clinicaland imaging parameters were compared between these groups. Independent risk factors for collateral circulation andprognosis of AIS patients were identified through multivariate Logistic regression analysis. A prediction model forunfavorable AIS prognosis was developed based on the results of multivariate Logistic analysis, and its predictive value wasassessed using receiver operating characteristic (ROC) curve analysis. Results Poor collateral circulation group exhibitedhigher proportions of insular ribbon and gray-white matter junction blurring as compared with good collateral circulation group (P<0.05), while the ratio of hypoperfusion intensity ratio (HIR) <0.3 was lower in poor collateral circulation group(P<0.05). Relative cerebral blood volume (rCBV) <40%, relative cerebral blood flow (rCBF) <30%, peak time (Tmax) >8 s,and Tmax>10 s volume were all significantly higher in poor collateral circulation group (P<0.05), whereas the Alberta strokeprogram early CT score (ASPECTS) was lower (P<0.05). Multivariate Logistic regression analysis identified ASPECTS,rCBV <40%, rCBF <30%, and Tmax>10 s as independent risk factors for poor collateral circulation (P<0.05). Unfavorableoutcome group had higher rates of hemorrhage following endovascular thrombectomy and mismatch ratio <1.8 thanfavorable outcome group (P<0.05), with a lower HIR<0.3 ratio (P<0.05). Compared with favorable outcome group,unfavorable outcome group also showed higher admission NIHSS scores, higher percentages of rCBV <40%, rCBF <30%,Tmax>4 s, Tmax>6 s, and Tmax>10 s volumes (P<0.05), but lower mCTA collateral circulation score (P<0.05). MultivariateLogistic regression analysis indicated that admission NIHSS score, mCTA collateral circulation score, rCBV <40%, rCBF<30%, and Tmax>10 s were independent risk factors for unfavorable outcomes (P<0.05). The regression equation wasformulated as: Logit(P) =-0.184+ (admission NIHSS score×0.134) + (mCTA collateral circulation score×-0.415) + (rCBV <40%×0.107)+(rCBF<30%×0.089)+(Tmax>10 s×0.028). ROC curve analysis demonstrated an area under the curve of 0.775(95 CI: 0.689-0.860, P<0.001) for the prediction model in assessing unfavorable AIS prognosis. Conclusion One-stop multimodality CT has significant application value in assessing collateral circulation and predicting prognosis in AIS patients.
Last Update: 2025-04-30