Research ArticleORIGINAL RESEARCH
Association of Pretreatment Perfusion Imaging Parameters With 90-Day Excellent Functional Outcomes in Anterior Circulation Distal Medium Vessel Occlusion Stroke
Hamza Adel Salim, Vaibhav Vagal, Dhairya A. Lakhani, Janet Mei, Licia Luna, Yasmin Aziz, Aneri Balar, Adam A. Dmytriw, Adrien Guenego, Basel Musmar, Nimer Adeeb, Victor C Urrutia, Elisabeth B Marsh, Raf Llinas, Argye E. Hillis, Hanzhang Lu, Risheng Xu, Dylan Wolman, Benjamin Pulli, Kambiz Nael, Max Wintermark, Jeremy J. Heit, Gregory W Albers, Tobias D. Faizy and Vivek Yedavalli
American Journal of Neuroradiology November 2024, ajnr.A8584; DOI: https://doi.org/10.3174/ajnr.A8584
Hamza Adel Salim
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDVaibhav Vagal
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDDhairya A. Lakhani
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDJanet Mei
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDLicia Luna
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDYasmin Aziz
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDAneri Balar
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDAdam A. Dmytriw
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MD MPH MScAdrien Guenego
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDBasel Musmar
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDNimer Adeeb
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDVictor C Urrutia
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDElisabeth B Marsh
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDRaf Llinas
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDArgye E. Hillis
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDHanzhang Lu
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MD PhDRisheng Xu
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDDylan Wolman
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDBenjamin Pulli
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDKambiz Nael
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDMax Wintermark
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDJeremy J. Heit
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MD PhDGregory W Albers
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDTobias D. Faizy
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MDVivek Yedavalli
From the Department of Radiology, Division of Neuroradiology, Johns Hopkins Medical Center, Baltimore, Maryland, USA (H.A.S., J.M., L.L., V.C.U., E.B.M., R.L., A.E.H., H.L., R.X., V.Y.); Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA (H.A.S., M.W.); Renaissance School of Medicine at Stony Brook University (V.V.); Department of Radiology, West Virginia University, Morgantown, WV, USA (D.A.L., A.B.); Department of Neurology, University of Cincinnati Medical Center, Cincinnati, OH (Y.A.); Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA (A.A.D.); Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada (A.A.D.); Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium (A.G.); Department of Neurosurgery and Interventional Neuroradiology, Louisiana State University, LA (B.M., N.A.); Department of Radiology, Brown University, Providence, RI, USA (D.W.); Department of Interventional Neuroradiology, Stanford Medical Center, Palo Alto, California, USA (B.P.); Department of Radiology & Biomedical Imaging, University of California, San Francisco, California, USA (K.N.); Department of Neuroimaging and Neurointervention, Stanford Medical Center, Palo Alto, California, USA (J.J.H., G.W.A.); Department of Radiology, Neuroendovascular Program, University Medical Center Münster, Germany (T.D.F.)
MD
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ABSTRACT
BACKGROUND AND PURPOSE: Acute ischemic strokes caused by distal medium vessel occlusions (DMVO) represent a significant proportion of all stroke cases, yet the predictors of excellent functional outcomes in these patients remain poorly understood. This study aims to identify pretreatment computed tomography perfusion (CTP) parameters associated with excellent functional outcomes, defined as a modified Rankin Scale (mRS) score of 0-1 at 90 days, in patients with anterior circulation DMVO.
MATERIALS AND METHODS: We conducted a retrospective multicenter study involving patients with anterior DMVO, from three stroke centers within the Johns Hopkins Medical Enterprise. Baseline demographic, clinical, and imaging data were collected, with CTP parameters analyzed using RAPIDAI software. Univariable and multivariable logistic regression models were used to identify predictors of excellent outcomes. Receiver operating characteristic (ROC) curves were constructed to assess the predictive accuracy of CTP parameters.
RESULTS: Among the 82 patients (median age, 71 years; 57% female), occlusions were located in the M2 segment in 89%, M3 in 8.5%, and A2 in 2.4%. IVT was administered to 37% of patients, and EVT was attempted in 59%. Excellent outcomes at 90 days were achieved in 45% of patients. In univariate analysis, white race (OR, 4.14; 95% CI, 1.66–10.9; P=0.003), higher CBV index (OR per 0.1-unit change, 1.45; 95% CI, 1.08–2.05; P=0.022), and lower relative cerebral blood flow (rCBF < 20%) volumes (OR, 0.91; 95% CI, 0.81–0.98; P=0.038) were significantly associated with excellent outcomes. In multivariate analysis adjusting for age, sex, race, IVT administration, EVT attempted, dyslipidemia, and premorbid mRS, higher CBV index remained a significant independent predictor (OR per 0.1-unit change, 1.72; 95% CI, 1.14–2.81; P=0.017), and lower rCBF < 20% volume was associated with better outcomes (OR, 0.91; 95% CI, 0.80–0.98; P=0.05). The multivariate model demonstrated good predictive performance (area under the ROC curve, 80%; 95% CI, 70%–90%; P < 0.001).
CONCLUSIONS: In patients with anterior circulation DMVO, a higher CBV index on pretreatment CTP is an independent predictor of excellent functional outcomes at 90 days. These findings suggest that CTP parameters, particularly the CBV index, may be useful in prognostic assessment for this stroke population. Further studies are needed to validate these results and optimize therapeutic approaches.
ABBREVIATIONS: ABC＝ definition; XYZ＝ definition.
- © 2024 by American Journal of Neuroradiology
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Accepted Manuscript
Hamza Adel Salim, Vaibhav Vagal, Dhairya A. Lakhani, Janet Mei, Licia Luna, Yasmin Aziz, Aneri Balar, Adam A. Dmytriw, Adrien Guenego, Basel Musmar, Nimer Adeeb, Victor C Urrutia, Elisabeth B Marsh, Raf Llinas, Argye E. Hillis, Hanzhang Lu, Risheng Xu, Dylan Wolman, Benjamin Pulli, Kambiz Nael, Max Wintermark, Jeremy J. Heit, Gregory W Albers, Tobias D. Faizy, Vivek Yedavalli
Association of Pretreatment Perfusion Imaging Parameters With 90-Day Excellent Functional Outcomes in Anterior Circulation Distal Medium Vessel Occlusion Stroke
American Journal of Neuroradiology Nov 2024, ajnr.A8584; DOI: 10.3174/ajnr.A8584
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Accepted Manuscript
Association of Pretreatment Perfusion Imaging Parameters With 90-Day Excellent Functional Outcomes in Anterior Circulation Distal Medium Vessel Occlusion Stroke
Hamza Adel Salim, Vaibhav Vagal, Dhairya A. Lakhani, Janet Mei, Licia Luna, Yasmin Aziz, Aneri Balar, Adam A. Dmytriw, Adrien Guenego, Basel Musmar, Nimer Adeeb, Victor C Urrutia, Elisabeth B Marsh, Raf Llinas, Argye E. Hillis, Hanzhang Lu, Risheng Xu, Dylan Wolman, Benjamin Pulli, Kambiz Nael, Max Wintermark, Jeremy J. Heit, Gregory W Albers, Tobias D. Faizy, Vivek Yedavalli
American Journal of Neuroradiology Nov 2024, ajnr.A8584; DOI: 10.3174/ajnr.A8584
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