ORIGINAL RESEARCH article
Front. Neurol.
Sec. Applied Neuroimaging
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1568717
Quantitative Insights into Stroke Recovery Utilizing Delayed Vessel Ratio from Color-coded Multiphase Computed Tomography Angiography
Provisionally accepted
- 1First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- 2Zhongshan Hospital, Xiamen University, Xiamen, Fujian Province, China
- 3Xiamen Humanity Hospital Fujian Medical University, Xiamen, China
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Background and objective:The color-coded multiphase computed tomography angiography (cmCTA) is an accredited technique that employs color-coding to visually depict the temporal dynamics of collateral blood flow in patients with acute ischemic stroke (AIS). This research aimed to assess the quantification of cmCTA in AIS patients for characterizing arterial and venous collateral flow, and predicting functional outcomes.Methods:A retrospective study was performed on a consecutive cohort of AIS patients with large vessel occlusion who underwent cmCTA scan and reconstruction. Collateral ratio and delayed vessel ratio (DVR) were determined through semi-automatic delineation and calculation on the anterior cerebral artery regions and Alberta Stroke Program Early CT (ASPECT) Score regions of cmCTA maps. Deep venous outflow (DVO) and superficial venous outflow (SVO) scores were assessed using a 6-point scale. Logistic regression and propensity score were applied to confounding factors adjustment and model construction. Receiver operating characteristic curve, calibration curve, and decision curve analysis were utilized to evaluate the prediction model of functional independence and excellent recovery.Results:Well-developed arterial collaterals as depicted by low DVR and adequate venous collaterals as indicated by high DVO or SVO were correlated with better outcomes (All P<0.001). Adjusted DVR showed areas under the curve of 0.81-0.90 for predicting functional independence and excellent recovery. Adjusted DVO showed areas under the curve of 0.88 for predicting functional independence and excellent recovery. Each prediction model demonstrated good precision and net benefit.Conclusion:The application of DVR and other parameters in cmCTA offers a quantitative perspective on the conventional ASPECT scoring scheme utilizing grayscale CT images. DVR from cmCTA may enhance pre-treatment collateral assessment and post-treatment outcome prediction in AIS, facilitating informed treatment decisions.
Keywords: computed tomography angiography, Collateral Circulation, Stroke, Delayed Vessel Ratio, Venous outflow
Received: 30 Jan 2025; Accepted: 03 Jun 2025.
Copyright: © 2025 Lin, Zhang, Xing, Yang, Tong, Lv, Wang and Cao. 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: Dairong Cao, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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