Clinical value of the MRA-MTC-rLMC score and cerebral blood flow changes in prognosis evaluation of chronic middle cerebral artery occlusion

IF 3.2 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology Pub Date : 2025-05-15 DOI:10.1016/j.ejrad.2025.112177

Xiangxiang Wu , Xingru Xu , Baodong Gu , Yun Meng , Kaixi Xu

{"title":"Clinical value of the MRA-MTC-rLMC score and cerebral blood flow changes in prognosis evaluation of chronic middle cerebral artery occlusion","authors":"Xiangxiang Wu , Xingru Xu , Baodong Gu , Yun Meng , Kaixi Xu","doi":"10.1016/j.ejrad.2025.112177","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the clinical value of improved three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) with magnetization transfer contrast (MTC) regional leptomeningeal collateral (MRA-MTC-rLMC) scoring and three-dimensional pseudo-continuous arterial spin labeling (3D-pcASL) in assessing cerebral blood flow (CBF) changes and predicting the prognosis of chronic middle cerebral artery occlusion (CMCAO).</div></div><div><h3>Methods</h3><div>This study included 45 patients with CMCAO. All patients underwent MRA, and 3D pcASL examinations and were classified into good and poor collateral circulation groups based on improved MRA-MTC-rLMC. Univariate analyses of clinical data were performed using independent sample t-tests, Mann-Whitney U tests, or Chi-square tests. The predictive ability of rLMC scores and CBF for adverse outcomes was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). Optimal cutoff values were used to categorize patients, and prognostic differences between groups were analyzed.</div></div><div><h3>Results</h3><div>Of the 45 patients, 16 (35.6 %) had right-side occlusion and 29 (64.4 %) had left-side occlusion. In the good collateral circulation group (19 cases, 42.2 %), 14 patients (73.7 %) exhibited high perfusion and 5 (26.3 %) showed low perfusion. In the poor collateral circulation group (26 cases, 57.8 %), 2 patients (7.7 %) exhibited high perfusion, while 24 (92.3 %) showed low perfusion. During follow-up, 22 patients experienced poor outcomes. The AUC for predicting poor prognosis was 0.913 (95 % CI: 0.818–1.000) for MRA-MTC-rLMC scores and 0.794 (95 % CI: 0.656–0.938) for CBF perfusion (both P < 0.001). The predictive ability of MRA-MTC-rLMC scores was significantly higher than that of CBF perfusion (Z = 2.001, P = 0.045).</div><div>CBF on the affected side was significantly higher in the good prognosis group compared to the poor prognosis group (t = 3.443, P = 0.001). The distribution of CBF differed significantly between the groups, with higher isothermal perfusion ratios observed in the good prognosis group (χ<sup>2</sup> = 22.607, P < 0.001). The good collateral circulation group had a higher good prognosis rate compared to the poor collateral group (χ<sup>2</sup> = 31.455, P < 0.001). Similarly, the high-perfusion group showed a higher good prognosis rate than the low-perfusion group (χ<sup>2</sup> = 19.050, P < 0.001).</div></div><div><h3>Conclusion</h3><div>The improved MRA-MTC-rLMC score and CBF changes can objectively reflect the varying degrees of collateral circulation and CBF in CMCAO. These methods provide reliable prognostic indicators and a basis for clinical decision-making in CMCAO management.</div></div>","PeriodicalId":12063,"journal":{"name":"European Journal of Radiology","volume":"189 ","pages":"Article 112177"},"PeriodicalIF":3.2000,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Radiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0720048X25002633","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

To evaluate the clinical value of improved three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) with magnetization transfer contrast (MTC) regional leptomeningeal collateral (MRA-MTC-rLMC) scoring and three-dimensional pseudo-continuous arterial spin labeling (3D-pcASL) in assessing cerebral blood flow (CBF) changes and predicting the prognosis of chronic middle cerebral artery occlusion (CMCAO).

Methods

This study included 45 patients with CMCAO. All patients underwent MRA, and 3D pcASL examinations and were classified into good and poor collateral circulation groups based on improved MRA-MTC-rLMC. Univariate analyses of clinical data were performed using independent sample t-tests, Mann-Whitney U tests, or Chi-square tests. The predictive ability of rLMC scores and CBF for adverse outcomes was assessed using the area under the receiver operating characteristic (ROC) curve (AUC). Optimal cutoff values were used to categorize patients, and prognostic differences between groups were analyzed.

Results

Of the 45 patients, 16 (35.6 %) had right-side occlusion and 29 (64.4 %) had left-side occlusion. In the good collateral circulation group (19 cases, 42.2 %), 14 patients (73.7 %) exhibited high perfusion and 5 (26.3 %) showed low perfusion. In the poor collateral circulation group (26 cases, 57.8 %), 2 patients (7.7 %) exhibited high perfusion, while 24 (92.3 %) showed low perfusion. During follow-up, 22 patients experienced poor outcomes. The AUC for predicting poor prognosis was 0.913 (95 % CI: 0.818–1.000) for MRA-MTC-rLMC scores and 0.794 (95 % CI: 0.656–0.938) for CBF perfusion (both P < 0.001). The predictive ability of MRA-MTC-rLMC scores was significantly higher than that of CBF perfusion (Z = 2.001, P = 0.045).

CBF on the affected side was significantly higher in the good prognosis group compared to the poor prognosis group (t = 3.443, P = 0.001). The distribution of CBF differed significantly between the groups, with higher isothermal perfusion ratios observed in the good prognosis group (χ² = 22.607, P < 0.001). The good collateral circulation group had a higher good prognosis rate compared to the poor collateral group (χ² = 31.455, P < 0.001). Similarly, the high-perfusion group showed a higher good prognosis rate than the low-perfusion group (χ² = 19.050, P < 0.001).

Conclusion

The improved MRA-MTC-rLMC score and CBF changes can objectively reflect the varying degrees of collateral circulation and CBF in CMCAO. These methods provide reliable prognostic indicators and a basis for clinical decision-making in CMCAO management.

查看原文本刊更多论文

MRA-MTC-rLMC评分及脑血流变化在慢性大脑中动脉闭塞预后评价中的临床价值

目的评价改良三维飞行时间磁共振血管造影（3D-TOF-MRA）结合磁化转移对比（MTC）局部脑脊膜侧支（mri -MTC- rlmc）评分和三维伪连续动脉自旋标记（3D-pcASL）在评估慢性大脑中动脉闭塞（CMCAO）患者脑血流量（CBF）变化及预测预后中的临床价值。方法本研究纳入45例CMCAO患者。所有患者均行MRA和3D pcASL检查，并根据改善的MRA- mtc - rlmc分为侧支循环良好组和不良组。采用独立样本t检验、Mann-Whitney U检验或卡方检验对临床资料进行单因素分析。rLMC评分和CBF对不良结局的预测能力采用受试者工作特征曲线下面积（AUC）进行评估。采用最佳临界值对患者进行分类，并分析组间预后差异。结果45例患者中，右侧闭塞16例（35.6%），左侧闭塞29例（64.4%）。侧支循环良好组19例（42.2%），高灌注14例（73.7%），低灌注5例（26.3%）。侧枝循环不良组26例（57.8%），高灌注2例（7.7%），低灌注24例（92.3%）。随访期间，22例患者预后不佳。MRA-MTC-rLMC评分预测预后不良的AUC为0.913 (95% CI: 0.818-1.000)， CBF灌注预测预后不良的AUC为0.794 (95% CI: 0.656-0.938) (P <；0.001)。MRA-MTC-rLMC评分的预测能力显著高于CBF灌注（Z = 2.001, P = 0.045）。预后良好组患侧CBF明显高于预后不良组（t = 3.443, P = 0.001）。两组间CBF分布差异有统计学意义，预后良好组等温灌注比较高(χ2 = 22.607, P <；0.001)。侧支循环良好组预后良好率高于侧支循环不良组(χ2 = 31.455, P <；0.001)。同样，高灌注组预后良好率高于低灌注组(χ2 = 19.050, P <；0.001)。结论改进后的MRA-MTC-rLMC评分及脑血流变化能客观反映CMCAO患者侧枝循环及脑血流的不同程度。这些方法为CMCAO治疗提供了可靠的预后指标和临床决策依据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

European Journal of Radiology 医学-核医学

CiteScore

6.70

自引率

3.00%

发文量

398

审稿时长

42 days

期刊介绍： European Journal of Radiology is an international journal which aims to communicate to its readers, state-of-the-art information on imaging developments in the form of high quality original research articles and timely reviews on current developments in the field. Its audience includes clinicians at all levels of training including radiology trainees, newly qualified imaging specialists and the experienced radiologist. Its aim is to inform efficient, appropriate and evidence-based imaging practice to the benefit of patients worldwide.