TY - JOUR
T1 - Automated collateral assessment restricted to the hypoperfused area for distal vessel occlusions in ischemic stroke
AU - de Vries, Lucas
AU - Robbe, M. M.Quirien
AU - Jansen, Ivo G.H.
AU - Mojtahedi, S. Mahsa
AU - Hoving, Jan W.
AU - Olthuis, Susanne G.H.
AU - Knapen, Robrecht R.M.M.
AU - Pinckaers, Florentina M.E.
AU - Kappelhof, Manon
AU - Beenen, Ludo F.M.
AU - Postma, Alida A.
AU - van Oostenbrugge, Robert J.
AU - Dippel, Diederik W.J.
AU - Gavves, Efstratios
AU - Emmer, Bart J.
AU - Majoie, Charles B.L.M.
AU - van Zwam, Wim H.
AU - Marquering, Henk A.
AU - Pinckaers, Floor
AU - Deniz, Rabia
AU - van der Ende, Nadinda A.M.
AU - Bruggeman, Agnetha A.E.
AU - Pirson, Anne F.A.V.
AU - Boodt, Nikki
AU - Ramos, Lucas A.
AU - Arrarte-Terreros, Nerea
AU - Prasetya, Haryadi
AU - Konduri, Praneeta R.
AU - LeCouffe, Natalie E.
AU - Groot, Adrien E.D.
AU - Collette, Sabine L.
AU - Schupp, Lieve M.
AU - Voogd, Eva J.H.F.
AU - Kirkels, Eleonora L.F.
AU - Weterings, Annick J.
AU - Alves, Heitor
AU - Tolhuisen, Manon L.
AU - Treurniet, Kilian M.
AU - van Kranendonk, Katinka R.
AU - Mens, Marieke A.
AU - Groot, P. F.C.
AU - Huguet, J.
AU - Boers, Anna M.M.
AU - de Jong, Anouk
AU - Muijres, Daan
AU - Harmsma, Roger R.M.
AU - Keizer, Koos
AU - van den Berg, Jan S.P.
AU - de Vries, J.
AU - Hofmeijer, Jeannette
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025/10
Y1 - 2025/10
N2 - Objectives: This study aims to: (1) develop and evaluate a quantitative assessment of collateral status in the downstream area of an occluded intracranial artery in acute ischemic stroke and compare this method to middle cerebral artery (MCA)-based assessment; (2) determine the agreement between the automated occlusion-downstream area collateral score (ODACS) and expert raters’ assessments, and compare this to inter-rater agreement. Methods: Patients from MR CLEAN-NO IV and MR CLEAN Registry with a proximal M1, distal M1, or M2 occlusion were included. Using the hypoperfused area from CT perfusion (CTP) as a proxy for the occlusion-downstream territory and automated vessel segmentations from CT angiography (CTA), ODACS is calculated as the vessel volume ratio between downstream ipsilateral and its contralateral regions. ODACS was compared to a whole MCA-territory approach and evaluated against visual scoring by two expert raters that visually estimated ODACS using CTA and CTP, and their inter-rater agreement. Results: The study included 204 patients with a proximal M1 (52%), distal M1 (32%), or M2 (16%) occlusion. ODACS yielded lower collateral scores than MCA-based scoring for all occlusion locations, with larger differences in more distal occlusions. For M2 occlusions, 58% of patients shifted from good (> 50%) to poor (≤ 50%) collateral filling of the occluded territory using ODACS. Moderate (weighted Cohen’s kappa κ = 0.45) inter-rater agreement and fair (κ = 0.35) to moderate (κ = 0.51) ODACS-rater agreement were observed. Conclusions: ODACS yields lower collateral scores compared to MCA-based scoring and is comparable to scores from expert raters. Key Points: Question CT angiography-based collateral assessment in the MCA territory is inadequate to assess the collateral status in patients with distal vessel occlusions. Findings Our automated ODACS revealed lower collateral scores than traditional whole-territory assessment, especially in distal vessel occlusions. Clinical relevance The more precise evaluation of affected brain territories through automated occlusion-downstream area assessments prevents an overestimation of collateral status in distal occlusions, which could lead to improved patient selection and treatment decisions in acute stroke care.
AB - Objectives: This study aims to: (1) develop and evaluate a quantitative assessment of collateral status in the downstream area of an occluded intracranial artery in acute ischemic stroke and compare this method to middle cerebral artery (MCA)-based assessment; (2) determine the agreement between the automated occlusion-downstream area collateral score (ODACS) and expert raters’ assessments, and compare this to inter-rater agreement. Methods: Patients from MR CLEAN-NO IV and MR CLEAN Registry with a proximal M1, distal M1, or M2 occlusion were included. Using the hypoperfused area from CT perfusion (CTP) as a proxy for the occlusion-downstream territory and automated vessel segmentations from CT angiography (CTA), ODACS is calculated as the vessel volume ratio between downstream ipsilateral and its contralateral regions. ODACS was compared to a whole MCA-territory approach and evaluated against visual scoring by two expert raters that visually estimated ODACS using CTA and CTP, and their inter-rater agreement. Results: The study included 204 patients with a proximal M1 (52%), distal M1 (32%), or M2 (16%) occlusion. ODACS yielded lower collateral scores than MCA-based scoring for all occlusion locations, with larger differences in more distal occlusions. For M2 occlusions, 58% of patients shifted from good (> 50%) to poor (≤ 50%) collateral filling of the occluded territory using ODACS. Moderate (weighted Cohen’s kappa κ = 0.45) inter-rater agreement and fair (κ = 0.35) to moderate (κ = 0.51) ODACS-rater agreement were observed. Conclusions: ODACS yields lower collateral scores compared to MCA-based scoring and is comparable to scores from expert raters. Key Points: Question CT angiography-based collateral assessment in the MCA territory is inadequate to assess the collateral status in patients with distal vessel occlusions. Findings Our automated ODACS revealed lower collateral scores than traditional whole-territory assessment, especially in distal vessel occlusions. Clinical relevance The more precise evaluation of affected brain territories through automated occlusion-downstream area assessments prevents an overestimation of collateral status in distal occlusions, which could lead to improved patient selection and treatment decisions in acute stroke care.
KW - Brain
KW - Collateral circulation
KW - Computed tomography angiography
KW - Perfusion imaging
KW - Stroke
UR - https://www.scopus.com/pages/publications/105010431991
U2 - 10.1007/s00330-025-11442-2
DO - 10.1007/s00330-025-11442-2
M3 - Article
C2 - 40227346
AN - SCOPUS:105010431991
SN - 0938-7994
VL - 35
SP - 6127
EP - 6139
JO - European radiology
JF - European radiology
IS - 10
ER -
SDG 3 Good Health and Well-being