The Compensation Index Is Better Associated with DSA ASITN Collateral Score Compared to the Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio

Dhairya A. Lakhani; Aneri B. Balar; Manisha Koneru; Sijin Wen; Meisam Hoseinyazdi; Cynthia Greene; Risheng Xu; Licia Luna; Justin Caplan; Adam A. Dmytriw; Adrien Guenego; Max Wintermark; Fernando Gonzalez; Victor Urrutia; Judy Huang; Kambiz Nael; Ansaar T. Rai; Gregory W. Albers; Jeremy J. Heit; Vivek S. Yedavalli

doi:10.3390/jcm12237365

Journal of Clinical Medicine (Nov 2023)

The Compensation Index Is Better Associated with DSA ASITN Collateral Score Compared to the Cerebral Blood Volume Index and Hypoperfusion Intensity Ratio

Dhairya A. Lakhani,
Aneri B. Balar,
Manisha Koneru,
Sijin Wen,
Meisam Hoseinyazdi,
Cynthia Greene,
Risheng Xu,
Licia Luna,
Justin Caplan,
Adam A. Dmytriw,
Adrien Guenego,
Max Wintermark,
Fernando Gonzalez,
Victor Urrutia,
Judy Huang,
Kambiz Nael,
Ansaar T. Rai,
Gregory W. Albers,
Jeremy J. Heit,
Vivek S. Yedavalli

Affiliations

Dhairya A. Lakhani: Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD 21218, USA
Aneri B. Balar: Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD 21218, USA
Manisha Koneru: Cooper Medical School, Rowan University, Camden, NJ 08028, USA
Sijin Wen: Department of Biostatistics, West Virginia University, Morgantown, WV 26506, USA
Meisam Hoseinyazdi: Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD 21218, USA
Cynthia Greene: Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD 21218, USA
Risheng Xu: Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21218, USA
Licia Luna: Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD 21218, USA
Justin Caplan: Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21218, USA
Adam A. Dmytriw: Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
Adrien Guenego: Department of Radiology, Université Libre De Bruxelles Hospital Erasme, 1070 Anderlecht, Belgium
Max Wintermark: Department of Radiology, University of Texas, MD Anderson Center, Houston, TX 77030, USA
Fernando Gonzalez: Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21218, USA
Victor Urrutia: Department of Neurology, Johns Hopkins University, Baltimore, MD 21218, USA
Judy Huang: Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21218, USA
Kambiz Nael: Division of Neuroradiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
Ansaar T. Rai: Department of Radiology, West Virginia University, Morgantown, WV 26506, USA
Gregory W. Albers: Department of Radiology, Stanford University School of Medicine, Stanford, CA 94063, USA
Jeremy J. Heit: Department of Radiology, Stanford University School of Medicine, Stanford, CA 94063, USA
Vivek S. Yedavalli: Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD 21218, USA

DOI: https://doi.org/10.3390/jcm12237365
Journal volume & issue: Vol. 12, no. 23
p. 7365

Abstract

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Background: Pretreatment CT Perfusion (CTP) parameters serve as reliable surrogates of collateral status (CS). In this study, we aim to assess the relationship between the novel compensation index (CI, Tmax > 4 s/Tmax > 6 s) and already established CTP collateral markers, namely cerebral blood volume (CBV) index and Hypoperfusion Intensity Ratio (HIR), with the reference standard American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score (CS) on DSA. Methods: In this retrospective study, inclusion criteria were the following: (a) CT angiography confirmed anterior circulation large vessel occlusion from 9 January 2017 to 10 January 2023; (b) diagnostic CT perfusion; and (c) underwent mechanical thrombectomy with documented DSA-CS. Student t-test, Mann–Whitney-U-test and Chi-square test were used to assess differences. Spearman’s rank correlation and logistic regression analysis were used to assess associations. p ≤ 0.05 was considered significant. Results: In total, 223 patients (mean age: 67.8 ± 15.8, 56% female) met our inclusion criteria. The CI (ρ = 0.37, p p p > 0.05) did not correlate with DSA-CS. On multivariate logistic regression analysis taking into account age, sex, ASPECTS, tPA, premorbid mRS, NIH stroke scale, prior history of TIA, stroke, atrial fibrillation, diabetes mellitus, hyperlipidemia, heart disease and hypertension, only CI was not found to be independently associated with DSA-CS (adjusted OR = 1.387, 95% CI: 1.09–1.77, p < 0.01). Conclusion: CI demonstrates a stronger correlation with DSA-CS compared to both the HIR and CBV Index where it may show promise as an additional quantitative pretreatment CS biomarker.

Published in Journal of Clinical Medicine

ISSN: 2077-0383 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine
Website: http://www.mdpi.com/journal/jcm

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