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Prognostic value of collateral perfusion estimation by arterial spin labeling for acute anterior circulation ischemic stroke

  • Diagnostic Neuroradiology
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Abstract

Purpose

This study aimed to verify the value of arterial spin labeling (ASL) collateral perfusion estimation for predicting functional outcomes in acute anterior circulation ischemic stroke.

Methods

This secondary analysis of an ongoing prospective observational study included data from participants with acute ischemic stroke due to steno-occlusion of the internal carotid artery and/or the middle cerebral artery within 8 h of symptom onset. We compared the collateral map, which is a 5-phase collateral imaging derived from dynamic contrast-enhanced magnetic resonance angiography, and ASL to validate the ASL collateral perfusion estimation. Multiple logistic regression analyses were conducted to identify independent predictors of favorable functional outcomes.

Results

One hundred forty-eight participants (68 ± 13 years, 96 men) were evaluated. The ASL collateral perfusion grade was positively correlated with the collateral perfusion grade of the collateral map (P < .001). Younger age (OR = 0.53, 95% CI = 0.36–0.78, P = .002), lower baseline NIHSS score (OR = 0.85, 95% CI = 0.78–0.92, P < .001), intermediate ASL collateral perfusion grade (OR = 4.02, 95% CI = 1.43–11.26, P = .008), good ASL collateral perfusion grade (OR = 26.37, 95% CI = 1.06–655.01, P = .046), and successful reperfusion (OR = 5.84, 95% CI = 2.08–16.42, P < .001) were independently associated with favorable functional outcomes.

Conclusion

ASL collateral perfusion estimation provides prognostic information, which can be helpful in guiding management decisions.

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Abbreviations

ASL:

Arterial spin labeling

CI:

Confidence interval

CT:

Computed tomography

DWI:

Diffusion-weighted imaging

MCA:

Middle cerebral artery

MR:

Magnetic resonance

mRS:

Modified Rankin scale

mTICI:

Modified thrombolysis in cerebral infarction

NIHSS:

National Institutes of Health Stroke Scale

OR:

Odds ratio

SWI:

Susceptibility-weighted imaging

Tmax:

Time-to-maximum

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Acknowledgements

This study was supported by a National Research Foundation of Korea (NRF) grant from the Korean government (No. NRF-2020R1F1A1071619, RS-2023-00248375, RS-2023-00252980, and RS-2023-00266130).

Funding

This study was supported by a National Research Foundation of Korea (NRF) grant from the Korean government (No. NRF-2020R1F1A1071619, RS-2023-00248375, RS-2023-00252980, and RS-2023-00266130).

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Authors and Affiliations

  1. Department of Neurology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Republic of Korea

    Taek-Jun Lee, Seon Young Ryu, Yu Jin Jung & Sang Bong Lee

  2. Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea

    Hong Gee Roh & Jin Woo Choi

  3. Department of Radiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea

    Hyun Jeong Kim

  4. Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea

    Yoo Sung Jeon

  5. Department of Neurosurgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea

    Hee Jong Ki & Hyung Jin Lee

  6. Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea

    Jeong Jin Park

  7. Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Ji Sung Lee

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  1. Taek-Jun Lee
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Contributions

Guarantors of the integrity of the entire study, T.-J. L., S. B. L., H. G. R., H. J. Kim.; study concepts/study design or data acquisition or data analysis/interpretation, T.-J. L., S. B. L., H. G. R., H. J. Kim., H. J. Ki, Y. S. J., J. S. L.; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of the final version of the submitted manuscript, all authors; agreement to ensure any questions related to the work are appropriately resolved, all authors; literature research, T.-J. L., S. B. L., H. J. Kim, H. G. R.; clinical studies, T.-J. L., S. B. L., H. G. R., H. J. Kim, Y. S. J., H. J. Ki, J. J. P., H. J. L., S. Y. R., Y. J. J.; technical support (experimental studies), H. G. R., J. W. C.; statistical analysis, J. S. L.; and manuscript editing, T.-J. L., S. B. L., H. G. R., H. J. Kim

Corresponding author

Correspondence to Sang Bong Lee.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethical approval

The local institutional review boards of Konkuk Medical Center (KUMC0114-01-100-007) and Daejeon St. Mary’s Hospital (DC21DIDI0050) approved this study.

All methods were carried out in accordance with relevant guidelines and regulations of the Declaration of Helsinki and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for reporting observational study.

Informed consent

Written informed consent was obtained from all patients in this study.

Additional information

Study subjects or cohorts overlap

Data from the study population of a study published in Radiology in 2020 were used. We included 148 participants from this population (Multiphase MR Angiography Collateral Map: Functional Outcome after Acute Anterior Circulation Ischemic Stroke. Radiology in 2020; 295(1):192-201).

The prior article dealt with the predictability of the Multiphase MR Angiography collateral map for functional outcomes of the patients with acute anterior circulation ischemic stroke whereas in this manuscript we report on the predictability of the ASL collateral perfusion estimation for functional outcomes.

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Lee, TJ., Roh, H.G., Kim, H.J. et al. Prognostic value of collateral perfusion estimation by arterial spin labeling for acute anterior circulation ischemic stroke. Neuroradiology 65, 1695–1705 (2023). https://doi.org/10.1007/s00234-023-03233-7

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  • DOI: https://doi.org/10.1007/s00234-023-03233-7

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