ORIGINAL RESEARCH article
Front. Neurol.
Sec. Applied Neuroimaging
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1553216
Dynamically Grading Cerebral Collateral Circulation Using 3D Multi-inversion Time Arterial Spin Labeling in Ischemic Stroke: A Comparison with Digital Subtraction Angiography
Provisionally accepted
- 1Department of Radiology, Tianjin Huanhu Hospital, Tianjin University, Tianjin, China
- 2Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
- 3Department of Radiology, Zhangqiu District People's Hospital, Jinan, Shandong Province, China
- 4MR Collaboration, Siemens Healthcare (China), Beijing, China
- 5MR Application Development, Siemens Healthcare GmbH, Erlangen, Germany
- 6Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin, China
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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). Conclusions: 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.
Keywords: dynamic perfusion imaging, Arterial Spin Labeling, Collateral Circulation, collateralgrade, ischemic stroke
Received: 30 Dec 2024; Accepted: 18 Aug 2025.
Copyright: © 2025 Kong, Feng, Yang, Qiao, Zhang, Pfeuffer and Han. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tong Han, Department of Radiology, Tianjin Huanhu Hospital, Tianjin University, Tianjin, China
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