Frontiers in neurology · 2025
Dynamically grading cerebral collateral circulation using 3D multi-inversion time arterial spin labeling in ischemic stroke: a comparison with digital subtraction angiography.
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Kong Chuili, Feng Quanzhi, Yang Tiantian, Qiao Shuwang, Zhang Xianchang, Pfeuffer Josef, Han Tong
Аннотация
OBJECTIVE: This study aims to introduce a novel non-invasive imaging method, 3D multi-inversion time arterial spin labeling (3D mTI-ASL), for grading collateral circulation in patients with acute ischemic stroke (AIS) and to compare its effectiveness with digital subtraction angiography (DSA).
METHODS: We analyzed data from 28 patients with unilateral internal carotid artery or middle cerebral artery occlusion who underwent both DSA and 3D mTI-ASL imaging before endovascular treatment. A post-processing pipeline was established to grade collateral flow based on 16 perfusion-weighted images. The agreement between the collateral grades derived from ASL and DSA was evaluated.
RESULTS: Strong interobserver agreement was observed for both DSA (κ = 0.856) and mTI-ASL (κ = 0.849). A moderate level of consistency in collateral grading between 3D mTI-ASL and DSA was noted (κ = 0.568, p < 0.001). This was improved when patients were categorized into poor and good collateral groups within both grading systems (k = 0.781, p < 0.001). Notably, patients with good collaterals (Grades 3-4) had significantly lower admission National Institutes of Health Stroke Scale scores compared to patients with poor collaterals (p < 0.028 for DSA and p < 0.015 for mTI-ASL).
CONCLUSION: The 3D mTI-ASL technique shows promise as a reliable, non-invasive method for assessing collateral circulation in AIS. By simulating DSA-derived grading, it may serve as a complementary tool in clinical decision-making for acute stroke management.
METHODS: We analyzed data from 28 patients with unilateral internal carotid artery or middle cerebral artery occlusion who underwent both DSA and 3D mTI-ASL imaging before endovascular treatment. A post-processing pipeline was established to grade collateral flow based on 16 perfusion-weighted images. The agreement between the collateral grades derived from ASL and DSA was evaluated.
RESULTS: Strong interobserver agreement was observed for both DSA (κ = 0.856) and mTI-ASL (κ = 0.849). A moderate level of consistency in collateral grading between 3D mTI-ASL and DSA was noted (κ = 0.568, p < 0.001). This was improved when patients were categorized into poor and good collateral groups within both grading systems (k = 0.781, p < 0.001). Notably, patients with good collaterals (Grades 3-4) had significantly lower admission National Institutes of Health Stroke Scale scores compared to patients with poor collaterals (p < 0.028 for DSA and p < 0.015 for mTI-ASL).
CONCLUSION: The 3D mTI-ASL technique shows promise as a reliable, non-invasive method for assessing collateral circulation in AIS. By simulating DSA-derived grading, it may serve as a complementary tool in clinical decision-making for acute stroke management.