Utility of Time-Variant Multiphase CTA Color Maps in Outcome Prediction for Acute Ischemic Stroke Due to Anterior Circulation Large Vessel Occlusion

Johanna M Ospel; Petra Cimflova; Ondrej Volny; Wu Qiu; Moiz Hafeez; Arnuv Mayank; Mohamed Najm; Kevin Chung; Nima Kashani; Mohammed A Almekhlafi; Bijoy K Menon; Mayank Goyal

doi:10.1007/s00062-020-00958-3

Utility of Time-Variant Multiphase CTA Color Maps in Outcome Prediction for Acute Ischemic Stroke Due to Anterior Circulation Large Vessel Occlusion

Clin Neuroradiol. 2021 Sep;31(3):783-790. doi: 10.1007/s00062-020-00958-3. Epub 2020 Sep 25.

Authors

Johanna M Ospel^{1

2}, Petra Cimflova^{1

3

4}, Ondrej Volny⁵, Wu Qiu¹, Moiz Hafeez¹, Arnuv Mayank¹, Mohamed Najm¹, Kevin Chung⁶, Nima Kashani^{1

7}, Mohammed A Almekhlafi^{1

7}, Bijoy K Menon^{1

7}, Mayank Goyal^{8

9}

Affiliations

¹ Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, T2N2T9, Calgary, AB, Canada.
² Department of Radiology, University Hospital of Basel, Basel, Switzerland.
³ Department of Medical Imaging, St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
⁴ International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
⁵ Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
⁶ Department of Medical Biophysics, University of Western Ontario, London, Canada.
⁷ Department of Radiology, University of Calgary, Calgary, Canada.
⁸ Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, T2N2T9, Calgary, AB, Canada. mgoyal@ucalgary.ca.
⁹ Department of Radiology, University of Calgary, Calgary, Canada. mgoyal@ucalgary.ca.

PMID: 32975611
DOI: 10.1007/s00062-020-00958-3

Abstract

Background: Multiphase CTA (mCTA) is an established tool for endovascular treatment decision-making and outcome prediction in acute ischemic stroke, but its interpretation requires some degree of experience. We aimed to determine whether mCTA-based prediction of clinical outcome and final infarct volume can be improved by assessing collateral status on time-variant mCTA color maps rather than using a conventional mCTA display format.

Methods: Patients from the PRove-IT cohort study with anterior circulation large vessel occlusion were included in this study. Collateral status was assessed with a three-point scale using the conventional display format. Collateral extent and filling dynamics were then graded on a three-point scale using time-variant mCTA color-maps (FastStroke, GE Healthcare, Milwaukee, WI, USA). Multivariable logistic regression was performed to determine the association of conventional collateral score, color-coded collateral extent and color-coded collateral filling dynamics with good clinical outcome and final infarct volume (volume below vs. above median infarct volume in the study sample).

Results: A total of 285 patients were included in the analysis and 53% (152/285) of the patients achieved a good outcome. Median infarct volume on follow-up was 12.6 ml. Color-coded collateral extent was significantly associated with good outcome (adjusted odds ratio [_adjOR] 0.53, 95% confidence interval [CI]:0.36-0.77) while color-coded collateral filling dynamics (_adjOR 1.30 [95%CI:0.88-1.95]) and conventional collateral scoring (_adjOR 0.72 [95%C:0.48-1.08]) were not. Both color-coded collateral extent (_adjOR 2.67 [95%CI:1.80-4.00]) and conventional collateral scoring (_adjOR 1.84 [95%CI:1.21-2.79]) were significantly associated with follow-up infarct volume, while color-coded collateral filling dynamics were not (_adjOR 1.21 [95%CI:0.83-1.78]).

Conclusion: In this study, collateral extent assessment on time-variant mCTA maps improved prediction of good outcome and has similar value in predicting follow-up infarct volume compared to conventional mCTA collateral grading.

Keywords: Collaterals; Ischemic stroke; Large vessel occlusion.

MeSH terms

Brain Ischemia* / diagnostic imaging
Cerebral Angiography
Cohort Studies
Collateral Circulation
Computed Tomography Angiography
Humans
Ischemic Stroke*
Retrospective Studies
Stroke* / diagnostic imaging