A Grading Scale for Pial Collaterals in Middle Cerebral Artery Total Occlusion Based on Time-of-flight MR Angiography Source Images

Yuan, Hong-Wen; Ji, Ren; Wang, An Li; Lin, Yue; Chen, Han Feng; Zi, Xu; Peng, Guixiang; Luo, Ben Yan

doi:10.2463/mrms.mp.2018-0001

Cited by 9 publications

(6 citation statements)

References 30 publications

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“…PCs of stenotic hemisphere were measured in the axial TOF‐MRA source images on the level of lateral ventricle body, reported by Yuan et al: grade 0, absent vascular signal; grade 1, decreased collaterals <50% than the reference side; grade 2, decreased collaterals ≥50% than the reference side; grade 3, equal to or more than the reference side. Poor PCs were defined as grade 0 or 1, and good PCs were defined as grade 2 or 3.…”

Section: Methodsmentioning

confidence: 99%

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Combination of Plaque Characteristics, Pial Collaterals, and Hypertension Contributes to Misery Perfusion in Patients With Symptomatic Middle Cerebral Artery Stenosis

Liu

Luo

Wang

et al. 2019

Magnetic Resonance Imaging

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Background: Atherosclerotic plaque in the middle cerebral artery (MCA) is linked to ischemic stroke events, but the relationship between plaque characteristics and cerebral perfusion is unclear. Purpose: To investigate MCA plaque characteristics between intracranial atherosclerotic patients with and without hypoperfusion area, and to identify the variables affecting hypoperfusion volume. Study Type: Retrospective. Population: Seventy-one patients with MCA stenosis (>50%), and all with ischemic onset in recent 2 weeks. Field Strength/Sequence: 3.0T MRI / diffusion-weighted imaging (DWI), time-of-flight magnetic resonance angiography (TOF-MRA), inversion-recovery prepared sampling perfection with application-optimized contrast using different flip angle evolutions (IR-SPACE), dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI). Assessment: Plaque characteristics including eccentric index (EI), eccentricity, plaque length, and enhancement on MCA were measured on IR-SPACE. Pial collaterals (PCs) were evaluated on axial TOF-MRA source images. Time-to-maximum (Tmax) maps with a threshold more than 6 seconds were assessed by rapid processing of perfusion and diffusion (RAPID) software. Statistical Tests: Two independent-samples t-tests, Mann-Whitney U-test, chi-square test, Z test, univariate and multivariate logistic analysis, and receiver operating characteristic (ROC) curve were used. Results: Patients with hypoperfusion had fewer eccentric plaque, lower EI, longer plaque length, and poor PCs compared with those without (P = 0.002, 0.016, 0.003, and 0.001). Eccentricity, plaque length, PCs, and hypertension were the factors independently associated with the occurrence of hypoperfusion after adjustment for risk factors of cerebrovascular disease (P = 0.014, 0.017, 0.035, and 0.018). The area under the curve (AUC) (95% confidence interval) was 0.865 (0.763-0.934) for a combination of the above four variables, which was significantly higher than any variable alone (P < 0.001, 0.016, < 0.001, and < 0.001). Patients with lower EI, concentric morphology, and grade 2 enhancement trended to have larger hypoperfusion volume (P = 0.028, 0.037, and 0.009). Data Conclusion: Plaque eccentricity, plaque length, PCs, and hypertension showed an association with the occurrence of hypoperfusion.

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Section: Methodsmentioning

confidence: 99%

“…Good collateral status can reduce final infarct volumes, and is associated with excellent outcomes in acute ischemic stroke patients as well . Collateral vessels on source TOF‐MRA were reported to be useful for showing pial collaterals (PCs) and predicting the clinical outcomes of patients with MCA occlusion and moyamoya disease …”

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confidence: 99%

Combination of Plaque Characteristics, Pial Collaterals, and Hypertension Contributes to Misery Perfusion in Patients With Symptomatic Middle Cerebral Artery Stenosis

Liu

Luo

Wang

et al. 2019

Magnetic Resonance Imaging

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“…The collateral score was assessed as from 0 to 4, depending on the modified system of Yuan et al [ 16 ]. Collateral scores were based on digital subtraction angiography (DSA).…”

Section: Methodsmentioning

confidence: 99%

“…By using a 5-point scale, we assessed the visualization grade of the arteries in the thrombosed segment and the overall course of occluded intracranial artery, including vessels of the distal-to-thrombus segment in NCT and CTA (Supplementary Table S1; Figures 2 and 3). The collateral score was assessed as from 0 to 4, depending on the modified system of Yuan et al [16]. Collateral scores were based on digital subtraction angiography (DSA).…”

Section: Image Analysismentioning

confidence: 99%

Piecing Arterial Branching Pattern Together from Non-Contrast and Angiographic Brain Computed Tomography before Endovascular Thrombectomy for Acute Ischemic Stroke

Lee

Shim

Jeong

et al. 2023

JCM

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Predicting the unseen arterial course and branching pattern distal to vessel occlusion is crucial for endovascular thrombectomy in acute stroke patients. We investigated whether a comprehensive interpretation of NCT and CTA would enhance arterial course prediction more than either NCT or CTA interpretation alone. Among 150 patients who achieved post-thrombectomy TICI grades ≥ IIb for anterior circulation occlusions, we assessed visualization grade on both NCT and CTA by five scales at the thrombosed and the distal-to-thrombus segment, using DSA as the reference standard. The visualization grades were compared and related to various subgroups. The mean visualization grade of the distal-to-thrombus segment on NCT was significantly larger than that of CTA (mean ± SD, 3.62 ± 0.87 versus 3.31 ± 1.20; p < 0.05). On CTA, visualization grade of distal-to-thrombus segment in the good collateral flow subgroup was higher than that in the poor collateral flow subgroup (mean ± SD, 4.01 ± 0.93 versus 2.56 ± 0.99; p < 0.001). After the comprehensive interpretation of NCT and CTA, seventeen cases (11%) showed visualization grade of distal-to-thrombus segment upgrading. Tracing arterial course and piecing branching patterns together in distal-to-occlusion of stroke patients was feasible on the routine pre-interventional NCT and CTA, which may provide timely guidance during thrombectomy.

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“…1 MMD affects children, as well as adults, and shows different clinical manifestations depending on the population: ischemic symptoms predominate in children, and intracranial hemorrhage is more frequent in adults than in children. [2][3][4][5][6][7][8] Most commonly affected areas are the frontal and parietal lobes, where the cerebral ischemia causes symptoms, such as hemiparesis and cognitive impairment. [9][10][11][12][13] For pediatric patients with MMD, comprehensive evaluation including brain MR is necessary to make the diagnosis and formulate the most appropriate treatment strategy.…”

Section: Introductionmentioning

confidence: 99%

Quiet Diffusion-weighted MR Imaging of the Brain for Pediatric Patients with Moyamoya Disease

et al. 2022

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Diffusion-weighted MRI (DWI) is an essential sequence for evaluating pediatric patients with moyamoya disease (MMD); however, acoustic noise associated with DWI may lead to motion artifact. Compared with conventional DWI (cDWI), quiet DWI (qDWI) is considered less noisy and able to keep children more relaxed and stable. This study aimed to evaluate the suitability of qDWI compared with cDWI for pediatric patients with MMD. Methods: In this observational study, MR examinations of the brain were performed either with or without sedation in pediatric patients with MMD between September 2017 and August 2018. Three neuroradiologists independently evaluated the images for artifacts and restricted diffusion in the brain. The differences between qDWI and cDWI were compared statistically using a chi-square test.Results: One-hundred and six MR scans of 56 patients with MMD (38 scans of 15 sedated patients: 6 boys and 9 girls; mean age, 5.2 years; range, 1-9 years; and 68 scans of 42 unsedated patients: 19 boys and 23 girls; mean age, 10.7 years; range, 7-16 years) were evaluated. MR examinations were performed either with or without sedation (except in one patient). In sedated patients, no artifact other than susceptibility was observed on qDWI, whereas four artifacts were observed on cDWI (P = .04). One patient awoke from sedation during cDWI scanning, while no patient awoke from sedation during qDWI acquisition. For unsedated patients, three scans showed artifacts on qDWI, whereas two scans showed artifacts on cDWI (P = .65). Regarding restricted diffusion, qDWI revealed three cases, while two cases were found on cDWI (P = .66). Conclusion: qDWI induced fewer artifacts compared with cDWI in sedated patients, and similar frequencies of artifacts were induced by qDWI and by cDWI in unsedated patients. qDWI showed restricted diffusion comparable to cDWI.

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A Grading Scale for Pial Collaterals in Middle Cerebral Artery Total Occlusion Based on Time-of-flight MR Angiography Source Images

Abstract: The grading scale based on TOF-MRAsi could be a new empirical approach for pial collateral evaluation. The clinical use of the proposed approach for identifying patients with total occlusion of middle cerebral artery with a high risk of poor outcome requires evaluation in further studies.

Cited by 9 publications

References 30 publications

Combination of Plaque Characteristics, Pial Collaterals, and Hypertension Contributes to Misery Perfusion in Patients With Symptomatic Middle Cerebral Artery Stenosis

Combination of Plaque Characteristics, Pial Collaterals, and Hypertension Contributes to Misery Perfusion in Patients With Symptomatic Middle Cerebral Artery Stenosis

Piecing Arterial Branching Pattern Together from Non-Contrast and Angiographic Brain Computed Tomography before Endovascular Thrombectomy for Acute Ischemic Stroke

Quiet Diffusion-weighted MR Imaging of the Brain for Pediatric Patients with Moyamoya Disease

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