title: Parametric Digital Subtraction Angiography Imaging for the Objective Grading of Collateral Flow in Acute Middle Cerebral Artery Occlusion.
abstract: OBJECTIVE
  To report the feasibility of parametric color-coded digital subtraction angiography (DSA) in complementing the traditional, subjective way of leptomeningeal collateral assessment in acute middle cerebral artery (MCA) occlusions.
  
  
  METHODS
  Thirty-three consecutive patients with acute MCA occlusion who received endovascular treatment were recruited for investigation. Eighteen of 33 consecutive patients were included. The target downstream territory (TDT) of MCA and reference point at terminal internal carotid artery of each patient was contoured by 5 raters independently on the basis of anteroposterior 2-dimensional DSA. Two parameters of relative maximum density of TDT (rDensitymax) and peak time interval (ΔPT) between reference and TDT were extracted by the use of parametric DSA analysis software. Interrater reliability was tested with intraclass correlation coefficients. Parameters with sufficient interrater reliability entered validity evaluation. Then, the correlation test with the American Society of Interventional and Therapeutic Neuroradiology collateral grading system and efficacy in predicting favorable clinical outcome was evaluated.
  
  
  RESULTS
  The intraclass correlation coefficient of rDensitymax and ΔPT were 0.983, 95% confidence interval 0.968-0.993 and 0.831, 95% confidence interval 0.705-0.923, respectively. The parameter rDensitymax showed a strong correlation with the American Society of Interventional and Therapeutic Neuroradiology collateral grading system score (r of Spearman correlation test = 0.869, P < 0.001) and mRS at 3 months (partial correlation coefficient = 0.616, P = 0.009), whereas ΔPT_average did not. A cut-off point of 0.224 in rDensitymax predicted a favorable clinical outcome with high sensitivity and specificity.
  
  
  CONCLUSIONS
  The relative maximum contrast density of MCA territory on 2-dimensional DSA measured by parametric imaging technique appears to be a simple and reliable metric for the assessment of leptomeningeal collaterals in cases of acute MCA occlusion.
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Shanghai, China.
authors.forename: Wan-Ling
authors.initials: WL
authors.lastname: Wen
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Shanghai, China.
authors.forename: Yi-Bin
authors.initials: YB
authors.lastname: Fang
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Shanghai, China.
authors.forename: Peng-Fei
authors.initials: PF
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Shanghai, China.
authors.forename: Yong-Wei
authors.initials: YW
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Shanghai, China.
authors.forename: Yi-Na
authors.initials: YN
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Shanghai, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Shen
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Shanghai, China.
authors.forename: Jia-Jia
authors.initials: JJ
authors.lastname: Ge
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Shanghai, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Hong
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Shanghai, China. Electronic address: ocinhqh@163.com.
authors.forename: Qing-Hai
authors.initials: QH
authors.lastname: Huang
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Shanghai, China. Electronic address: chstroke@126.com.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods*; D001783:Blood Flow Velocity; D002533:Cerebral Angiography / Q000379:methods*; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: Acute ischemic stroke; Assessment; Collateral; Digital subtraction angiography; Parametric