Defining reperfusion post endovascular therapy in ischemic stroke using MR-dynamic contrast enhanced perfusion |
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| Authors: | Christopher D d&#x Esterre,Rani Gupta Sah,Zarina Assis,Aron S. Talai,Andrew M. Demchuk,Michael D. Hill,Mayank Goyal,Ting-Yim Lee,Nils D. Forkert,Philip A. Barber |
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| Affiliation: | 1.Department of Clinical Neurosciences, Calgary Stroke Program, Calgary, Canada;2.Seaman Family Centre, Foothills Medical Centre, Calgary, AB, Canada;3.Department of Radiology, University of Calgary, Calgary, AB, Canada;4.Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada;5.Department of Clinical Neurosciences, Calgary, AB, Canada;6.Lawson Health Research Institute, Robarts Research Institute, London, ON, Canada |
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| Abstract: | ObjectivesCerebral blood flow (CBF) measurements after endovascular therapy (EVT) for acute ischemic stroke are important to distinguish early secondary injury related to persisting ischemia from that related to reperfusion when considering clinical response and infarct growth.MethodsWe compare reperfusion quantified by the modified Thrombolysis in Cerebral Infarction Score (mTICI) with perfusion measured by MRI dynamic contrast-enhanced perfusion within 5 h of EVT anterior circulation stroke. MR perfusion (rCBF, rCBV, rTmax, rT0) and mTICI scores were included in a predictive model for change in NIHSS at 24 h and diffusion-weighted imaging (DWI) lesion growth (acute to 24 h MRI) using a machine learning RRELIEFF feature selection coupled with a support vector regression.ResultsFor all perfusion parameters, mean values within the acute infarct for the TICI-2b group (considered clinically good reperfusion) were not significantly different from those in the mTICI <2b (clinically poor reperfusion). However, there was a statistically significant difference in perfusion values within the acute infarct region of interest between the mTICI-3 group versus both mTICI-2b and <2b (p = 0.02). The features that made up the best predictive model for change in NIHSS and absolute DWI lesion volume change was rT0 within acute infarct ROI and admission CTA collaterals respectively. No other variables, including mTICI scores, were selected for these best models. The correlation coefficients (Root mean squared error) for the cross-validation were 0.47 (13.7) and 0.51 (5.7) for change in NIHSS and absolute DWI lesion volume change.ConclusionMR perfusion following EVT provides accurate physiological approach to understanding the relationship of CBF, clinical outcome, and DWI growth.Advances in knowledgeMR perfusion CBF acquired is a robust, objective reperfusion measurement providing following recanalization of the target occlusion which is critical to distinguish potential therapeutic harm from the failed technical success of EVT as well as improve the responsiveness of clinical trial outcomes to disease modification. |
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