Improved outcome prediction in large vessel occlusion stroke: A comparison of Tmax-based hypoperfusion ratios HIR10/4 and HIR10/6

IF 2.1 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-12-01 Epub Date: 2025-11-24 DOI:10.1016/j.jstrokecerebrovasdis.2025.108504

Jeewon Chon MA , Ashley Treanor BS , Andrew C. Pickles BS , William Y. Shin BA , Ronak H. Jani MD , John T. Tsiang MD , Amy Wozniak MS , Anthony W. Kam MD, PhD , David P. Pasquale MD , Joseph C. Serrone MD , Brandon J. Bond MD

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Abstract

Background

The hypoperfusion intensity ratio (HIR), derived from CT perfusion (CTP), reflects collateral flow quality, but its optimal formulation remains unsettled.

Objective

To compare the prognostic utility of conventional HIR_10/6 (time-to-maximum [T_max] >10s / >6 s) with an alternative HIR_10/4 (T_max >10s / >4 s) in patients undergoing endovascular thrombectomy (EVT).

Methods

We retrospectively analyzed consecutive large-vessel occlusion (LVO) strokes treated with EVT at our quaternary academic medical center (2015–2024). CTP was processed using RAPID software. Primary outcomes were modified Rankin Scale (mRS) at discharge and at 90 days. Secondary outcomes included National Institutes of Health Stroke Scale (NIHSS) at discharge and hemorrhagic transformation on follow-up imaging. Ordinal and linear regression models were adjusted for age, sex, vascular risk factors, intravenous thrombolysis, presentation window, and transfer status. Receiver operating characteristic (ROC) curves assessed discriminative performance.

Results

Among 280 patients (mean age 70 ±15 years; 49 % male), mean HIR_10/6 was 0.418 and HIR_10/4 was 0.241. Each 0.1-unit increase in HIR_10/4 translated to 31 % higher odds of worse mRS at discharge (adjusted odds ratio [aOR] 1.31, 95 % CI 1.12–1.54; p=0.001), 24 % higher odds of worse mRS at 90 days (aOR 1.24, 95 % CI 1.04–1.48; p=0.016), and higher discharge NIHSS (β=0.88, 95 % CI 0.05–1.71; p=0.039). HIR_10/6 showed weaker associations and was not significant for discharge NIHSS. Neither HIR metric demonstrated meaningful discrimination for hemorrhagic transformation or dichotomized outcomes (area under the curve [AUC] 0.50–0.52).

Conclusions

Incorporating mildly delayed tissue (T_max >4 s) may enhance the physiologic sensitivity of HIR. HIR_10/4 may be a potential prognostic biomarker; however, prospective validation is needed, and its standalone ability to discriminate binary outcomes remains limited.

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改进的大血管闭塞卒中预后预测：基于tmax的低灌注比HIR10/4和HIR10/6的比较

背景：由CT灌注（CTP）得出的低灌注强度比（HIR）反映了侧支血流质量，但其最佳公式仍未确定。目的：比较常规HIR10/6（时间至最大[Tmax] >0秒 / >6s）与替代HIR10/4 （Tmax >0秒 / >4s）在血管内取栓（EVT）患者中的预后价值。方法：回顾性分析2015-2024年在我院第四医学中心接受EVT治疗的连续大血管闭塞（LVO）脑卒中患者。采用RAPID软件对CTP进行处理。主要结果是出院时和90天时的修正Rankin量表（mRS）。次要结果包括出院时的美国国立卫生研究院卒中量表（NIHSS）和随访成像时的出血转化。排序和线性回归模型根据年龄、性别、血管危险因素、静脉溶栓、呈现窗口和转移状态进行调整。受试者工作特征（ROC）曲线评估鉴别表现。结果：280例患者（平均年龄70 ±15岁，男性49%），平均HIR10/6为0.418，HIR10/4为0.241。HIR10/4每增加0.1个单位，出院时mRS恶化的几率增加31%（校正比值比[aOR] 1.31, 95% CI 1.12-1.54; p=0.001）， 90天mRS恶化的几率增加24% (aOR 1.24, 95% CI 1.04-1.48; p=0.016)，出院时NIHSS升高（β=0.88, 95% CI 0.05-1.71; p=0.039）。HIR10/6与出院NIHSS的相关性较弱，且不显著。两项HIR指标均未显示出出血转化或二分类结果的显著区别（曲线下面积[AUC] 0.50-0.52）。结论：纳入轻度延迟组织（Tmax b>s）可提高HIR的生理敏感性。HIR10/4可能是一个潜在的预后生物标志物；然而，需要前瞻性验证，并且其单独区分二元结果的能力仍然有限。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.