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Automated collateral assessment restricted to the hypoperfused area for distal vessel occlusions in ischemic stroke.

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Title: Automated collateral assessment restricted to the hypoperfused area for distal vessel occlusions in ischemic stroke.
Authors: de Vries, Lucas1,2,3 (AUTHOR) lucas.devries@amsterdamumc.nl, Robbe, M. M. Quirien4,5 (AUTHOR), Jansen, Ivo G. H.6,7 (AUTHOR), Mojtahedi, S. Mahsa1,2 (AUTHOR), Hoving, Jan W.2 (AUTHOR), Olthuis, Susanne G. H.5,8,9,10 (AUTHOR), Knapen, Robrecht R. M. M.5,11 (AUTHOR), Pinckaers, Florentina M. E.4,12 (AUTHOR), Kappelhof, Manon2,7 (AUTHOR), Beenen, Ludo F. M.2,7 (AUTHOR), Postma, Alida A.11,13,14,15 (AUTHOR), van Oostenbrugge, Robert J.5,8,9,10 (AUTHOR), Dippel, Diederik W. J.16,17 (AUTHOR), Gavves, Efstratios3 (AUTHOR), Emmer, Bart J.2,7 (AUTHOR), Majoie, Charles B. L. M.2,7 (AUTHOR), van Zwam, Wim H.5,10,11,14 (AUTHOR), Marquering, Henk A.1,2 (AUTHOR), van der Lugt, Aad18 (AUTHOR), Roos, Yvo B. W. E. M.19 (AUTHOR)
Source: European Radiology. Oct2025, Vol. 35 Issue 10, p6127-6139. 13p.
Subjects: Ischemic stroke, Arterial occlusions, Perfusion, Patient selection, Perfusion imaging, Cerebral arteries
Abstract: 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: QuestionCT angiography-based collateral assessment in the MCA territory is inadequate to assess the collateral status in patients with distal vessel occlusions. FindingsOur automated ODACS revealed lower collateral scores than traditional whole-territory assessment, especially in distal vessel occlusions. Clinical relevanceThe 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. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Automated collateral assessment restricted to the hypoperfused area for distal vessel occlusions in ischemic stroke.
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  Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. Oct2025, Vol. 35 Issue 10, p6127-6139. 13p.
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  Data: 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: QuestionCT angiography-based collateral assessment in the MCA territory is inadequate to assess the collateral status in patients with distal vessel occlusions. FindingsOur automated ODACS revealed lower collateral scores than traditional whole-territory assessment, especially in distal vessel occlusions. Clinical relevanceThe 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. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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