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A novel method to assess pial collateralization from stroke perfusion MRI: subdividing Tmax into anatomical compartments

  • Magnetic Resonance
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Abstract

Objectives

To develop and validate a quantitative and observer-independent method to evaluate pial collateral circulation by DSC-perfusion MRI and test whether this novel method delivers diagnostic information which is redundant to or independent from conventional penumbra imaging by the mismatch approach.

Methods

We retrospectively identified 47 patients with M1 occlusion who underwent MR diffusion/perfusion imaging and mechanical thrombectomy at our facility. By automated registration and segmentation, Tmax delays were attributed specifically to the pial, cortical and parenchymal compartments. The resulting pial volumes at delay were defined as the pial Tmax map-assessed collateral score (TMACS) and correlated with gold standard digital subtraction angiography (DSA). Mismatch ratio was assessed by conventional penumbra defining MRI criteria.

Results

Strong correlation was found between TMACS and angiographically assessed collateral score (Pearson ρ = -0.74, p < 0.001). In multiple logistic regression, both good collaterals according to TMACS [OR 4.3 (1.1–19, p = 0.04)] and mismatch ratio ≥ 3.5 [OR 12.3 (1.88–249, p = 0.03)] were independent predictors of favourable clinical outcome.

Conclusions

Perfusion delay in the pial compartment, as evaluated by TMACS, closely reflects the extent of pial collaterals in gold-standard DSA. TMACS and mismatch ratio were found to be complementary predictors of a favourable clinical outcome, each adding independent predictive information.

Key Points

• MRI-DSC perfusion delay specific in the pial compartment reflects leptomeningeal collateralization.

• A novel quantitative- and observer-independent marker of collateral status (TMACS) is introduced.

• Quantification of collateral status leads to an independent predictor of neurological outcome.

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Acknowledgments

The scientific guarantor of this publication is M. Pham. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic study, performed at one institution.

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Correspondence to Arne Potreck.

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Potreck, A., Seker, F., Hoffmann, A. et al. A novel method to assess pial collateralization from stroke perfusion MRI: subdividing Tmax into anatomical compartments. Eur Radiol 27, 618–626 (2017). https://doi.org/10.1007/s00330-016-4415-2

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  • DOI: https://doi.org/10.1007/s00330-016-4415-2

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