Abstract T P33: Collateral Grade on MRI - Validation With Conventional Angiography is Key
Introduction: Collateral status may predict outcomes after endovascular therapy, yet a reliable noninvasive technique prior to angiography is needed. We developed a novel method for projection of perfusion imaging data and validated it with respect to DSA acquired immediately afterwards.
Methods: Consecutive acute ischemic stroke patients with M1 MCA occlusions with perfusion MR imaging prior to endovascular revascularization therapy were included. Collateral status on DSA was graded with the ASITN/SIR scale (0-4). 4-D dynamic susceptibility contrast concentration time images were constructed and projected in 2-D axial and sagittal planes at each time point. Independent review of the resulting MRI-based collateral sequences was conducted to generate a score analogous to the ASITN/SIR scale, followed by correlation studies between the two techniques.
Results: 47 patients were included with mean age 68.5 ± 16.3, 76.5% were female, baseline NIHSS was median 14 (range 3-31), and mean time from MRI to groin puncture was 109 min ± 95.5. DSA collateral grade was (0 (n=3); 1 (n=9); 2 (n=12); 3 (n=21); 4 (n=2)) with MRI collateral grade (0 (n=2); 1 (n=11); 2 (n=13); 3 (n=18); 4 (n=2)). MRI and DSA collateral scores were closely correlated, Spearman's rho = 0.91, weighted kappa = 0.82 (P <0.00001). Poor collateral status on MRI showed correlations with moderate to severe NIHSS (Spearman's rho = -0.31 (p< 0.039)). Figure depicts a panel version of MRI-based collateral sequences from a patient with a left M1 occlusion with a MR collateral grade of 1.
Conclusions: Novel post-processing of noninvasive MRI perfusion data based on routine acquisitions can reliably measure the degree of collaterals on DSA.
Author Disclosures: K.L. Ng: None. J.L. Saver: None. J.R. Alger: None. F. Scalzo: None. N. Salamon: None. B. Yoo: None. S. Starkman: None. L.K. Ali: None. N. Rao: None. J. Hinman: None. M. Calderon-Arnulphi: None. R. Modir: None. A. Tansy: None. C.W. Liang: None. S.A. Sheth: None. A.R. Noorian: None. P. Vespa: None. M.B. Blanco: None. R. Jahan: None. F. Vinuela: None. G.R. Duckwiler: None. S. Tateshima: None. N. Gonzalez: None. D.S. Liebeskind: None.
- © 2014 by American Heart Association, Inc.