Correlation of Collateral Scores Derived from Whole-Brain Time-Resolved Flat Panel Detector Imaging in Acute Ischemic Stroke

C C Kurmann; J Kaesmacher; S Pilgram-Pastor; E I Piechowiak; A Scutelnic; M R Heldner; T Dobrocky; J Gralla; P Mordasini

doi:10.3174/ajnr.A7657

Correlation of Collateral Scores Derived from Whole-Brain Time-Resolved Flat Panel Detector Imaging in Acute Ischemic Stroke

AJNR Am J Neuroradiol. 2022 Nov;43(11):1627-1632. doi: 10.3174/ajnr.A7657. Epub 2022 Oct 6.

Authors

C C Kurmann^{1

2}, J Kaesmacher¹, S Pilgram-Pastor¹, E I Piechowiak¹, A Scutelnic³, M R Heldner³, T Dobrocky¹, J Gralla¹, P Mordasini⁴

Affiliations

¹ From the University Institute of Diagnostic and Interventional Neuroradiology (C.C.K., J.K., S.P.-P., E.I.P., T.D., J.G., P.M.).
² University Institute of Diagnostic and Interventional and Pediatric Radiology (C.C.K.).
³ Department of Neurology (A.S., M.R.H.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
⁴ From the University Institute of Diagnostic and Interventional Neuroradiology (C.C.K., J.K., S.P.-P., E.I.P., T.D., J.G., P.M.) Pasquale.mordasini@insel.ch.

Abstract

Background and purpose: Flat panel detector CT imaging allows simultaneous acquisition of multiphase flat panel CTA and flat panel CTP imaging directly in the angio suite. We compared collateral assessment derived from multiphase flat panel CTA and flat panel CTP with collateral assessment derived from DSA as the gold-standard.

Materials and methods: We performed a retrospective analysis of patients with occlusion of the first or second segment of the MCA who underwent pre-interventional flat panel detector CT. The hypoperfusion intensity ratio as a correlate of collateral status was calculated from flat panel CTP (time-to-maximum > 10 seconds volume/time-to-maximum > 6 seconds volume). Intraclass correlation coefficients were calculated for interrater reliability for the Calgary/Menon score for multiphase flat panel CTA and for the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) score for DSA collateral scores. Correlations of the hypoperfusion intensity ratio, multiphase flat panel CTA score, and the ASITN/SIR score were calculated using the Spearman correlation.

Results: From November 2019 to February 2020, thirty patients were included. Moderate interrater reliability was achieved for the ASITN/SIR DSA score (0.68; 95% CI, 0.50-0.82) as well as for the Calgary/Menon multiphase flat panel CTA score (0.53; 95% CI, 0.29-0.72). We found a strong correlation between the ASITN/SIR DSA and Calgary/Menon multiphase flat panel CTA score (ρ = 0.54, P = .002) and between the hypoperfusion intensity ratio and the Calgary/Menon multiphase flat panel CTA score (ρ = -0.57, P < .001). The correlation was moderate between the hypoperfusion intensity ratio and the ASITN/SIR DSA score (ρ = -0.49, P = .006). The infarct core volume correlated strongly with the Calgary/Menon multiphase flat panel CTA score (ρ = -0.66, P < .001) and the hypoperfusion intensity ratio (ρ = 0.76, P < .001) and correlated moderately with the ASITN/SIR DSA score (ρ = -0.46, P = .01).

Conclusions: The Calgary/Menon multiphase flat panel CTA score and the hypoperfusion intensity ratio correlated with each other and with the ASITN/SIR DSA score as the gold-standard. In our cohort, the collateral scoring derived from flat panel detector CT was clinically reliable.

MeSH terms

Brain
Brain Ischemia* / diagnostic imaging
Brain Ischemia* / therapy
Cerebral Angiography / methods
Collateral Circulation
Computed Tomography Angiography / methods
Humans
Ischemic Stroke*
Reproducibility of Results
Retrospective Studies
Stroke* / diagnostic imaging
Stroke* / therapy