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  The ratio between cerebral blood flow and Tmax predicts the quality of collaterals in acute ischemic stroke

Galinovic, I., Kochova, E., Khalil, A., Villringer, K., Piper, S. K., & Fiebach, J. B. (2018). The ratio between cerebral blood flow and Tmax predicts the quality of collaterals in acute ischemic stroke. PLoS One, 13(1): e0190811. doi:10.1371/journal.pone.0190811.

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Item Permalink: http://hdl.handle.net/21.11116/0000-0000-751F-B Version Permalink: http://hdl.handle.net/21.11116/0000-0003-A0C5-9
Genre: Journal Article

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 Creators:
Galinovic, Ivana1, Author
Kochova, Elena2, Author
Khalil, Ahmed1, 3, 4, Author              
Villringer, Kersten1, Author
Piper, Sophie K.1, 5, Author
Fiebach, Jochen B.1, Author
Affiliations:
1Center for Stroke Research, Charité University Medicine Berlin, Germany, ou_persistent22              
2International Graduate Program Medical Neurosciences, Charité University Medicine Berlin, Germany, ou_persistent22              
3Berlin School of Mind and Brain, Humboldt University Berlin, Germany, ou_persistent22              
4Department Neurology, MPI for Human Cognitive and Brain Sciences, Max Planck Society, ou_634549              
5Institute of Medical Biometrics and Clinical Epidemiology, Charité University Medicine Berlin, Germany, ou_persistent22              

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 Abstract: Background In acute ischemic stroke the status of collateral circulation is a critical factor in determining outcome. We propose a less invasive alternative to digital subtraction angiography for evaluating collaterals based on dynamic-susceptibility contrast magnetic resonance imaging. Methods Perfusion maps of Tmax and cerebral blood flow (CBF) were created for 35 patients with baseline occlusion of a major cerebral artery. Volumes of hypoperfusion were defined as having a Tmax delay of > 4 seconds (Tmax4s) and > 6 seconds (Tmax6s) and a CBF drop below 80% of healthy, contralateral tissue. For each patient a ratio between the volume of the CBF and the Tmax based perfusion deficit was calculated. Associations with collateral status and radiological outcome were assessed with the Mann-Whitney-U test, uni- and multivariable logistic regression analyses as well as area under the receiver-operator-characteristic (ROC) curve. Results The CBF/Tmax volume ratios were significantly associated with bad collateral status in crude logistic regression analysis as well as with adjustment for NIHSS at admission and baseline infarct volume (OR = 2.5 95% CI[1.2–5.4] p = 0.020 for CBF/Tmax 4s volume ratio and OR = 1.6 95% CI[1.0–2.6] p = 0.031 for CBF/Tmax6s volume ratio). Moreover, the ratios were significantly correlated to final infarct size (Spearman’s rho = 0.711 and 0.619, respectively for the CBF/Tmax4s volume ratio and CBF/Tmax6s volume ration, all p<0.001). The ratios also had a high area under the ROC curve of 0.93 95%CI[0.86–1.00]) and 0.90 95%CI[0.80–1.00]respectively for predicting poor radiological outcome. Conclusions In the setting of acute ischemic stroke the CBF/Tmax volume ratio can be used to differentiate between good and insufficient collateral circulation without the need for invasive procedures like conventional angiography.

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Language(s): eng - English
 Dates: 2017-03-242017-12-202018-01-30
 Publication Status: Published online
 Pages: -
 Publishing info: -
 Table of Contents: -
 Rev. Method: Peer
 Identifiers: DOI: 10.1371/journal.pone.0190811
PMID: 29381701
PMC: PMC5790218
Other: eCollection 2018
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Grant ID : 01EO0801 ; 01EO01301
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Funding organization : German Federal Ministry of Education and Research (BMBF)

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Title: PLoS One
Source Genre: Journal
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Publ. Info: San Francisco, CA : Public Library of Science
Pages: - Volume / Issue: 13 (1) Sequence Number: e0190811 Start / End Page: - Identifier: ISSN: 1932-6203
CoNE: https://pure.mpg.de/cone/journals/resource/1000000000277850