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• Clinical Article •
The study on the correlation between hypoperfusion intensity ratio and angiography collateral circulation in acute ischemic stroke before endovascular thrombectomy therapy
XU Jia  PENG Mingyang  ZHOU Wenzhen  WANG Tongxing  ZHAO Xiaojing  ZHOU Xingfan  YIN Xindao  DING Li 

Cite this article as: Xu J, Peng MY, Zhou WZ, et al. The study on the correlation between hypoperfusion intensity ratio and angiography collateral circulation in acute ischemic stroke before endovascular thrombectomy therapy. Chin J Magn Reson Imaging, 2020, 11(11): 971-974, 1055. DOI:10.12015/issn.1674-8034.2020.11.003.


[Abstract] Objective: To investigate the correlation between hypoperfusion intensity ratio (HIR) and collateral circulation using digital subtraction angiography (DSA) in acute ischemic stroke.Materials and Methods: A total of 100 acute ischemic stroke patients receiving endovascular thrombectomy therapy in our study from January 2017 to March 2020 were analyzed retrospectively. All patients underwent MRI examination [diffusion weighted imaging (DWI)], perfusion weighted imaging (PWI)) before therapy. American Society of Interventional and Therapeutic Neuroradiology (ASITN) grading system was used to evaluate the collateral circulation. ASITN 0—2 grade was poor collateral circulation and ASITN 3—4 was good collateral circulation. HIR was defined as the ratio of the time-to-maximum (Tmax)>10 s over Tmax> 6 s lesion volumes. The difference was statistically significant (t=9.547, P=0.007; t=7.596, P<0.001; t=7.118, P=0.016; t=-5.753, P<0.001). Spearman rank correlation and ROC analysis were performed to evaluate the correlation between HIR and collateral circulation.Results: The Tmax> 6 s (91.62±12.40 vs 125.73±17.91), Tmax>10 s (26.14±17.74 vs 58.23±29.96), PWI-DWI mismatch volume (72.52±10.08 vs 89.63±14.60) and HIR value (0.33±0.08 vs 0.43±0.09) in good collaterals group (ASITN 3—4) (n=51) was significantly lower than those in poor collaterals group (ASITN 0—2) (n=49). Spearman rank correlation analysis showed that there was a negative correlation between HIR and ASITN (r=-0.672; P<0.001). ROC analysis showed that the area under the curve of HIR predicting acute stroke collateral circulation was 0.801 (95% CI: 0.714—0.888). When the optimal cut-off value of HIR was 0.40, the sensitivity and specificity for predicting collateral circulation was 77.60% and 74.51% respectively.Conclusions: There is a close relationship between the low HIR and good collateral circulation in patients with acute ischemic stroke before endovascular thrombectomy therapy. Compared with gold standard DSA, HIR is a reliable measurement index of collateral circulation, and HIR<0.4 is the best predicted good DSA collaterals.
[Keywords] stroke；magnetic resonance imaging；diffusion weighted imaging；perfusion weighted imaging

XU Jia Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 21006, China

PENG Mingyang Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 21006, China

ZHOU Wenzhen Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 21006, China

WANG Tongxing Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 21006, China

ZHAO Xiaojing Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 21006, China

ZHOU Xingfan Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 21006, China

YIN Xindao Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 21006, China

DING Li* Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 21006, China

*Correspondence to: Ding L, E-mail: 21062817@qq.com

Conflicts of interest   None.

ACKNOWLEDGMENTS  This article is supported by the Jiangsu Science and Technology Development Project No. BE2017614 This article is supported by the Medical and Health Research Project of Nanjing Health and Family Planning Commission No. YKK18101
Received  2020-06-16
Accepted  2020-09-28
DOI: 10.12015/issn.1674-8034.2020.11.003
Cite this article as: Xu J, Peng MY, Zhou WZ, et al. The study on the correlation between hypoperfusion intensity ratio and angiography collateral circulation in acute ischemic stroke before endovascular thrombectomy therapy. Chin J Magn Reson Imaging, 2020, 11(11): 971-974, 1055. DOI:10.12015/issn.1674-8034.2020.11.003.

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