Color-coded collateral and venous outflow patterns in estimating infarct progression and predicting functional independence for stroke patients in late time window

Yu Lin; Zhen Xing; Shaomao Lv; Xiefeng Yang; Jianghe Kang; Nannan Kang; Jinan Wang; Dairong Cao

doi:10.1093/bjr/tqae104

Color-coded collateral and venous outflow patterns in estimating infarct progression and predicting functional independence for stroke patients in late time window

Br J Radiol. 2024 May 16:tqae104. doi: 10.1093/bjr/tqae104. Online ahead of print.

Authors

Yu Lin^{1

2

3}, Zhen Xing^{1

4}, Shaomao Lv^{2

3

5

6}, Xiefeng Yang^{1

4}, Jianghe Kang^{2

3}, Nannan Kang², Jinan Wang^{2

3}, Dairong Cao^{1

4

7

8}

Affiliations

¹ Department of Radiology, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China.
² Department of Radiology, Zhongshan Hospital Affiliated to Xiamen University, School of Medicine, Xiamen University, Xiamen 361004, China.
³ Xiamen Radiology Quality Control Center, Zhongshan Hospital Affiliated to Xiamen University, School of Medicine, Xiamen University, Xiamen 361004, China.
⁴ Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China.
⁵ School of Clinical Medicine, Fujian Medical University, Fuzhou 350005, China.
⁶ The Third Clinical Medical College, Fujian Medical University, Fuzhou 350005, China.
⁷ Fujian Provincial Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China.
⁸ Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, the First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China.

PMID: 38754104
DOI: 10.1093/bjr/tqae104

Abstract

Objectives: To investigate whether cerebral collateral and venous outflow patterns on color-coded multi-phase computed tomography angiography (mCTA) can estimate ischemic core growth rate (IGR) and predict 90-day functional independence for patients with late-presenting acute ischemic stroke (AIS).

Methods: The retrospective analysis included 127 AIS patients with a late time window. All patients underwent baseline mCTA with color-coded reconstruction and computed tomography perfusion. Both collateral score and venous outflow (VO) score on color-coded mCTA maps were analyzed and recorded. The IGR was calculated as ischemic core volume divided by the time from onset to imaging. A 90-day modified Rankin Scale score of 0-2 was defined as functional independence. Kendall's Tau-b analysis was used for nonparametric correlation analysis. Propensity scores, logistic regressions, and receiver operator characteristic (ROC) curves were applied to construct the prediction model.

Results: Moderate correlations were found between collateral delay and IGR (Tau-b = -0.554) and between VO and IGR (Tau-b = -0.501). High collateral score (odds ratio = 3.01) and adequate VO (odds ratio = 4.89) remained independent predictors for 90-day functional independence after adjustment. The joint predictive model, which integrated the VO score and clinical features, demonstrated an area under the ROC curve (AUC) of 0.878. The AUCs of collateral score and VO score were 0.836 and 0.883 for outcome prediction after adjustment.

Conclusions: Cerebral collateral and VO patterns based on color-coded mCTA can effectively predict infarct progression and 90-day clinical outcomes, even for AIS patients beyond the routine time window.

Advances in knowledge: Color-coded mCTA is a readily understandable post-processing technique for the rapid assessment of collateral circulation and VO status in stroke imaging. A moderate correlation was observed between the characteristics of collateral delay/VO on color-coded mCTA and IGR in patients with acute ischemic stroke. Both high-quality collateral circulation and "red superficial middle cerebral vein sign" can predict 90-day functional independence even for patients beyond the routine time window.