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Correlation between Hypoperfusion Intensity Ratio and Functional Outcome in Large-Vessel Occlusion Acute Ischemic Stroke: Comparison with Multi-Phase CT Angiography

Background and purpose: Previous studies have shown that Hypoperfusion Intensity Ratio (HIR) derived from Perfusion Imaging (PWI) associated with collateral status in large-vessel occlusion (LVO) acute ischemic stroke (AIS) and could predict the rate of collateral flow, speed of infarct growth, and...

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Autores principales: Wan, Zhifang, Meng, Zhihua, Xie, Shuangcong, Fang, Jin, Li, Li, Chen, Zhensong, Liu, Jinwu, Jiang, Guihua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9503156/
https://www.ncbi.nlm.nih.gov/pubmed/36142924
http://dx.doi.org/10.3390/jcm11185274
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author Wan, Zhifang
Meng, Zhihua
Xie, Shuangcong
Fang, Jin
Li, Li
Chen, Zhensong
Liu, Jinwu
Jiang, Guihua
author_facet Wan, Zhifang
Meng, Zhihua
Xie, Shuangcong
Fang, Jin
Li, Li
Chen, Zhensong
Liu, Jinwu
Jiang, Guihua
author_sort Wan, Zhifang
collection PubMed
description Background and purpose: Previous studies have shown that Hypoperfusion Intensity Ratio (HIR) derived from Perfusion Imaging (PWI) associated with collateral status in large-vessel occlusion (LVO) acute ischemic stroke (AIS) and could predict the rate of collateral flow, speed of infarct growth, and clinical outcome after endovascular treatment (EVT). We hypothesized that HIR derived from CT Perfusion (CTP) imaging could relatively accurately predict the functional outcome in LVO AIS patients receiving different types of treatment. Methods: Imaging and clinical data of consecutive patients with LVO AIS were retrospectively reviewed. Multi-phase CT angiography (mCTA) scoring was performed by 2 blinded neuroradiologists. CTP images were processed using an automatic post-processing analysis software. Correlation between the HIR and the functional outcome was calculated using the Spearman correlation. The efficacy of the HIR and the CTA collateral scores for predicting prognosis were compared. The optimal threshold of the HIR for predicting favorable functional outcome was determined using receiver operating characteristic (ROC) curve analysis. Results: 235 patients with LVO AIS were included. Patients with favorable functional outcome had lower HIR (0.1 [interquartile range (IQR), 0.1–0.2]) vs. 0.4 (IQR, 0.4–0.5)) and higher mCTA collateral scores (3 [IQR, 3–4] vs. 3 [IQR, 2–3]; p < 0.001) along with smaller infarct core volume (2.1 [IQR, 1.0–4.5]) vs. (15.2 [IQR, 5.5–39.3]; p < 0.001), larger mismatch ratio (22.9 [IQR, 11.6–45.6]) vs. (5.8 [IQR, 2.6–14]); p < 0.001), smaller ischemic volume (59.0 [IQR, 29.7–89.2]) vs. (97.5 [IQR, 68.7–142.2]; p < 0.001), and smaller final infarct volume (12.6 [IQR, 7.5–18.4]) vs. (78.9 [IQR, 44.5–165.0]; p < 0.001) than those with unfavorable functional outcome. The HIR was significantly positively correlated with the functional outcome [r = 0.852; 95% confidence interval (CI): 0.813–0.884; p < 0.0001]. The receiver operating characteristic (ROC) analysis showed that the optimal threshold for predicting a favorable functional outcome was HIR ≤ 0.3 [area under the curve (AUC) 0.968; sensitivity 88.89%; specificity 99.21%], which was higher than the mCTA collateral score [AUC 0.741; sensitivity 82.4%; specificity 48.8%]. Conclusions: HIR was associated with the functional outcome of LVO AIS patients, and the correlation coefficient was higher than mCTA collateral score. HIR outperformed mCTA collateral score in predicting functional outcome.
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spelling pubmed-95031562022-09-24 Correlation between Hypoperfusion Intensity Ratio and Functional Outcome in Large-Vessel Occlusion Acute Ischemic Stroke: Comparison with Multi-Phase CT Angiography Wan, Zhifang Meng, Zhihua Xie, Shuangcong Fang, Jin Li, Li Chen, Zhensong Liu, Jinwu Jiang, Guihua J Clin Med Article Background and purpose: Previous studies have shown that Hypoperfusion Intensity Ratio (HIR) derived from Perfusion Imaging (PWI) associated with collateral status in large-vessel occlusion (LVO) acute ischemic stroke (AIS) and could predict the rate of collateral flow, speed of infarct growth, and clinical outcome after endovascular treatment (EVT). We hypothesized that HIR derived from CT Perfusion (CTP) imaging could relatively accurately predict the functional outcome in LVO AIS patients receiving different types of treatment. Methods: Imaging and clinical data of consecutive patients with LVO AIS were retrospectively reviewed. Multi-phase CT angiography (mCTA) scoring was performed by 2 blinded neuroradiologists. CTP images were processed using an automatic post-processing analysis software. Correlation between the HIR and the functional outcome was calculated using the Spearman correlation. The efficacy of the HIR and the CTA collateral scores for predicting prognosis were compared. The optimal threshold of the HIR for predicting favorable functional outcome was determined using receiver operating characteristic (ROC) curve analysis. Results: 235 patients with LVO AIS were included. Patients with favorable functional outcome had lower HIR (0.1 [interquartile range (IQR), 0.1–0.2]) vs. 0.4 (IQR, 0.4–0.5)) and higher mCTA collateral scores (3 [IQR, 3–4] vs. 3 [IQR, 2–3]; p < 0.001) along with smaller infarct core volume (2.1 [IQR, 1.0–4.5]) vs. (15.2 [IQR, 5.5–39.3]; p < 0.001), larger mismatch ratio (22.9 [IQR, 11.6–45.6]) vs. (5.8 [IQR, 2.6–14]); p < 0.001), smaller ischemic volume (59.0 [IQR, 29.7–89.2]) vs. (97.5 [IQR, 68.7–142.2]; p < 0.001), and smaller final infarct volume (12.6 [IQR, 7.5–18.4]) vs. (78.9 [IQR, 44.5–165.0]; p < 0.001) than those with unfavorable functional outcome. The HIR was significantly positively correlated with the functional outcome [r = 0.852; 95% confidence interval (CI): 0.813–0.884; p < 0.0001]. The receiver operating characteristic (ROC) analysis showed that the optimal threshold for predicting a favorable functional outcome was HIR ≤ 0.3 [area under the curve (AUC) 0.968; sensitivity 88.89%; specificity 99.21%], which was higher than the mCTA collateral score [AUC 0.741; sensitivity 82.4%; specificity 48.8%]. Conclusions: HIR was associated with the functional outcome of LVO AIS patients, and the correlation coefficient was higher than mCTA collateral score. HIR outperformed mCTA collateral score in predicting functional outcome. MDPI 2022-09-07 /pmc/articles/PMC9503156/ /pubmed/36142924 http://dx.doi.org/10.3390/jcm11185274 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Wan, Zhifang
Meng, Zhihua
Xie, Shuangcong
Fang, Jin
Li, Li
Chen, Zhensong
Liu, Jinwu
Jiang, Guihua
Correlation between Hypoperfusion Intensity Ratio and Functional Outcome in Large-Vessel Occlusion Acute Ischemic Stroke: Comparison with Multi-Phase CT Angiography
title Correlation between Hypoperfusion Intensity Ratio and Functional Outcome in Large-Vessel Occlusion Acute Ischemic Stroke: Comparison with Multi-Phase CT Angiography
title_full Correlation between Hypoperfusion Intensity Ratio and Functional Outcome in Large-Vessel Occlusion Acute Ischemic Stroke: Comparison with Multi-Phase CT Angiography
title_fullStr Correlation between Hypoperfusion Intensity Ratio and Functional Outcome in Large-Vessel Occlusion Acute Ischemic Stroke: Comparison with Multi-Phase CT Angiography
title_full_unstemmed Correlation between Hypoperfusion Intensity Ratio and Functional Outcome in Large-Vessel Occlusion Acute Ischemic Stroke: Comparison with Multi-Phase CT Angiography
title_short Correlation between Hypoperfusion Intensity Ratio and Functional Outcome in Large-Vessel Occlusion Acute Ischemic Stroke: Comparison with Multi-Phase CT Angiography
title_sort correlation between hypoperfusion intensity ratio and functional outcome in large-vessel occlusion acute ischemic stroke: comparison with multi-phase ct angiography
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9503156/
https://www.ncbi.nlm.nih.gov/pubmed/36142924
http://dx.doi.org/10.3390/jcm11185274
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