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Rofo 2019; 191(09): 827-835
DOI: 10.1055/a-0825-6660
Neuroradiology
© Georg Thieme Verlag KG Stuttgart · New York

Noninvasive Collateral Flow Velocity Imaging in Acute Ischemic Stroke: Intraindividual Comparison of 4D-CT Angiography with Digital Subtraction Angiography

Nichtinvasive Bildgebung der Füllungsgeschwindigkeit der bestehenden Kollateralen bei akutem Schlaganfall: Intraindividueller Vergleich der 4D-CTA mit der digitalen Subtraktionsangiografie
Iris Muehlen
1   Neuroradiology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
,
Stephan P. Kloska
2   Radiology, Klinikum Furth, Germany
,
Philipp Gölitz
1   Neuroradiology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
,
Philip Hölter
1   Neuroradiology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
,
Lorenz Breuer
3   Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
,
Hendrik Ditt
4   Diagnostic Imaging, Computed Tomography, Siemens Healthcare GmbH Forchheim, Bayern, DE, Forchheim, Germany
,
Arnd Doerfler
1   Neuroradiology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
› Institutsangaben
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Publikationsverlauf

13. August 2018

14. Dezember 2018

Publikationsdatum:
21. Januar 2019 (online)

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Abstract

Purpose The collateral status can be defined not only by its morphological extent but also by the velocity of collateral filling characterized by the relative filling time delay (rFTD). The aim of our study was to compare different methods of noninvasive visualization of rFTD derived from 4D-CT angiography (4D-CTA) with digital substraction angiography (DSA) and to investigate the correlation between functional and morphological collateral status on timing-invariant CTA.

Materials and Methods 50 consecutive patients with acute occlusion in the M1 segment who underwent DSA for subsequent mechanical recanalization after multimodal CT were retrospectively analyzed. 4D-CTA data were used to assess the relative filling time delay between the A1 segment of the affected hemisphere and the sylvian branches distal to the occluded M1 segment using source images (4D-CTA-SI) and color-coded flow velocity visualization with prototype software (fv-CTA) in comparison to DSA. The morphological extent of collaterals was assessed on the basis of the Collateral Score (CS) on temporal maximum intensity projections (tMIP) derived from CT perfusion data.

Results There was very good correlation of rFTD between fv-CTA and DSA (n = 50, r = 0.9, p < 0.05). Differences of absolute rFTD values were not significant. 4D-CTA-SI and DSA also showed good correlation (n = 50, r = 0.6, p < 0.05), but mean values of rFTD were significantly different (p < 0.05). rFTD derived from fvCTA and CS derived from timing-invariant CTA showed a negative association (R = – 0.5; P = 0.000). In patients with a favorable radiological outcome defined by a TICI score of 2b or 3, there was a significant negative correlation of CS and mRS at 3 months (R = – 0.4, P = 0.006).

Conclusion Collateral status plays an important role in the outcome in stroke patients. rFTD derived from 4D-CTA is a suitable parameter for noninvasive imaging of collateral velocity, which correlates with the morphological extent of collaterals. Further studies are needed to define valid thresholds for rFTD and to evaluate the diagnostic and prognostic value.

Key points: 

  • Collateral supply in anterior circulation stroke can be defined by the velocity of collateral filling

  • Relative filling time delay (rFTD) can serve for quantitative measurement of collateral flow and correlates with the morphological extent of collaterals

  • 4D-CTA is a suitable noninvasive imaging technique

Citation Format

  • Muehlen I, Kloska SP, Gölitz P et al. Noninvasive Collateral Flow Velocity Imaging in Acute Ischemic Stroke: Intraindividual Comparison of 4D-CT Angiography with Digital Subtraction Angiography. Fortschr Röntgenstr 2019; 191: 827 – 835

Zusammenfassung

Hintergrund Der Kollateralisierungs-Status kann nicht nur qualitativ anhand der morphologischen Ausdehnung der Kollateralen, sondern auch quantitativ anhand der relativen Füllungsverzögerung (rFTD) bestimmt werden. Ziel unserer Studie war es, verschiedene Methoden der nichtinvasiven Darstellung der rFTD, abgeleitet aus der 4D-CT-Angiografie (4D-CTA), mit der digitalen Subtraktionsangiografie (DSA) zu vergleichen und den Zusammenhang zwischen dem funktionellen und morphologischen Kollateralisierungs-Status zu untersuchen.

Methode Retrospektiv wurden 50 Patienten mit akutem M1-Verschluss, bei denen nach Anfertigung eines multimodalen CTs eine DSA zur mechanischen Re-Kanalisation erfolgte, untersucht. Zur Bestimmung der relativen Füllungsverzögerung im A1-Segment der betroffenen Hemisphäre gegenüber den Mediaästen in der Sylvischen Fissur distal des M1-Verschlusses wurden die 4D-CTA-Datensätze herangezogen. Es wurden zum einen die Rohdaten (4D-CTA-SI), zum anderen eine Prototyp-Software mit farbkodierter Darstellung der Füllungsgeschwindigkeiten (fv-CTA) mit der DSA verglichen. Der morphologische Kollateralisierungs-Status wurde anhand der aus den CT-Perfusionsdaten berechneten zeitinvarianten CTA mithilfe des Collateral Score (CS) ermittelt.

Ergebnisse Die Korrelation der rFTD zwischen der fv-CTA und DSA war sehr gut (n = 50, r = 0,9, p < 0,05). Die Unterschiede zwischen den absoluten rFTD-Werten waren nicht signifikant. 4D-CTA-SI und DSA zeigten ebenfalls eine gute Korrelation (n = 50, r = 0,6, p < 0,05), allerdings unterschieden sich hier die Mittelwerte der rFTD signifikant (p < 0,05). Die aus der fvCTA abgeleitete rFTD und der anhand der zeitinvarianten CTA berechnete CS zeigten einen negativen Zusammenhang (R = – 0,5, P = 0,000). Bei den Patienten mit erfolgreicher Re-Kanalisation (TICI 2b/3) bestand eine signifikante negative Korrelation zwischen dem CS und dem mRS nach 3 Monaten (R = – 0,4, P = 0,006).

Schlussfolgerung Der Kollateralisierungs-Status spielt eine bedeutende Rolle für das Outcome bei Schlaganfall-Patienten. Die aus der 4D-CTA abgeleitete rFTD stellt einen adäquaten Parameter zur nichtinvasiven funktionellen Bildgebung des Kollateralisierungs-Status dar und korreliert mit dem morphologischen Kollateralisierungs-Status. Zur Definition valider Schwellenwerte und zur Evaluation der diagnostischen und prognostischen Relevanz sind weitere Studien nötig.

Kernaussagen: 

  • Anhand der Füllungsgeschwindigkeit der Kollateralen kann der Kollateralisierungs-Status bei akutem Schlaganfall bestimmt werden.

  • Die relative Anflutungsverzögerung (rFTD) kann zur quantitativen Bestimmung der Kollateralisierung dienen und korreliert mit dem morphologischen Kollateralisierungs-Status.

  • Die 4D-CTA ist hierbei eine adäquate nichtinvasive Bildgebungstechnik.

Key words

cerebral angiography - stroke - 4D-CTA - collateral supply - relative filling time delay - CT angiography
 

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