Investigation of the relationship between infarct volume expansion, disability and collateral circulation data obtained from triphasic CT angiography and ct perfusion in patients with acute middle cerebral artery (MCA) oclusion

Objective: Ischemic stroke is a serious condition that causes mortality and morbidity. Use of appropriate imaging methods is important to evaluate patients, to diagnose and their treatment options in ischemic stroke. The revealing of the dynamic penumbra area is one of the other leading steps for treatment in ischemic stroke patients. In the light of this information, we aimed to investigate the relationship between collateral flow assessment performed by triphasic CT angiography and CT perfusion examination with infarct growth established from control imaging after 1 week and disability after 3 months in patients with middle cerebral artery (MCA) M1 and M2 occlusion in the emergency department with an ischemic stroke clinic. Materials and Methods: The study was conducted as a prospective, descriptive, case series study in the neurology department of Ankara City Hospital between the dates of 01.02.2020 – 01.10.2020. 36 patients omitted the study. Demographic information of all patients was recorded. Triphasic CT angiography and CT perfusion performed while patients referred to emergency department. After that, control cranial imaging was performed at an average of 1 week during their hospitalization. Images were analyzed at the workstation. Patients' NIHSS at first admission and at the 1st week, mRS at the 3rd month and the Barthel Index for Activities of Daily Living at the 3rd month were calculated. The relationship between perfusion parameters that belongs to penumbral information obtained from CT perfusion and collateral circulation information that obtained from CT angiography with infarct growth and functional outcome was investigated. IBM SPSS Statistics 21.0 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) was used for the statistic analysis of the data, and the statistical significance value was accepted as 'p <0.05'. Results: The mean age of the individuals in the study was found 73.47±10.67. 52.8% of the individuals were men. 72.3% of the patients had a poor functional outcome according to mRS at the 3rd month. According to the mpBTA Menon collateral score, the infarct volume growth showed a statistically significant difference between the groups (p=0.037). The mRS scores at 3rd month did not show statistically significant difference between the groups according to the mpBTA Menon collateral score (p=0.073) The infarct volume growth showed different distribution between the groups according to the mRS score and Barthel Index at 3rd month (p=0.001, p=0.020). The mean value of the MTT belongs to penumbra obtained from the MTT/CBV map showed a statistically significant difference between the groups according to the mRS at 3rd month (p=0.011). Conclusion: With the collateral circulation information obtained from triphasic CT angiography, the patients' final infarct volume and infarct volume growth can be predicted. In addition, the final infarct volume and the growth of infarct volume affect the disability of the patients. It can be interpreted on the patient's disability and the increase in infarct volume by using penumbral MTT value and the penumbral volume information obtained from the BTP maps created by different threshold values. Keywords: Stroke, Collateral, CT angiography, CT perfusion, mRS, Barthel