Pretreatment CT perfusion collateral parameters correlate with penumbra salvage in middle cerebral artery occlusion

Dhairya A. Lakhani, Aneri B. Balar, Manisha Koneru, Meisam Hoseinyazdi, Nathan Hyson, Andrew Cho, Cynthia Greene, Risheng Xu, Licia Luna, Justin Caplan, Adam Dmytriw, Adrien Guenego, Max Wintermark, Fernando Gonzalez, Victor Urrutia, Judy Huang, Kambiz Nael, Ansaar T. Rai, Gregory W. Albers, Jeremy J. HeitVivek Yedavalli

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4 Scopus citations


Background and Purpose: Acute ischemic stroke due to large vessel occlusion (AIS-LVO) is a major cause of functional dependence. Collateral status (CS) is an important determinant of functional outcomes. Pretreatment CT perfusion (CTP) parameters serve as reliable surrogates of CS. Penumbra Salvage Index (PSI) is another parameter predictive of functional outcomes in AIS-LVO. The aim of this study is to assess the relationship of pretreatment CTP parameters with PSI. Methods: In this prospectively collected, retrospectively reviewed multicenter analysis, inclusion criteria were as follows: (1) CT angiography confirmed middle cerebral artery (MCA) M1-segment and proximal M2-segment occlusion from 9/1/2017 to 9/22/2022; (2) diagnostic CTP; and (3) available diagnostic Magnetic resonance Imaging (MRI) diffusion-weighted images. Pearson correlation analysis was performed to assess the association between cerebral blood volume (CBV) index and hypoperfusion intensity ratio (HIR) with PSI. p value ≤.05 was considered statistically significant. Results: In total, 131 patients (n = 86, M1 and n = 45, proximal M2 occlusion) met our inclusion criteria. CBV index showed a modest positive correlation with PSI (r = 0.34, p<.001) in patients with proximal MCA occlusion. Similar trends were noted in subgroup analysis of patients with M1 occlusion, and proximal M2 occlusion. Whereas, HIR did not have a strong trend or correlation with PSI. Conclusion: CBV index correlates with PSI, whereas HIR does not. Future studies are needed to expand our understanding of the adjunct role of CBV index with other similar pretreatment CTP-based markers in clinical evaluation and decision-making in patients with MCA occlusion.

Original languageEnglish
Pages (from-to)44-49
Number of pages6
JournalJournal of Neuroimaging
Issue number1
StatePublished - 1 Jan 2024
Externally publishedYes


  • CBV index
  • HIR
  • Penumbra Salvage Index
  • acute ischemic stroke
  • collateral status
  • hypoperfusion intensity ratio


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