Validation of CT perfusion-based vascular territory mapping: correlation to visual pial grading and outcome measures

Vascular territory mapping (VTM) software estimates which intracerebral vessel provides peak arterial flow to a brain voxel. This observational study was performed to assess the hypothesis that the VTM algorithm may correlate to visual measurements of leptomeningeal grading and stroke outcome measur...

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Main Authors: Michael Valente, Henry Ma, Andrew Bivard, Bernard Yan, Mark Parsons, Chushuang Chen, Milanka Visser
Format: Article
Language:English
Published: BMJ Publishing Group 2025-02-01
Series:BMJ Neurology Open
Online Access:https://neurologyopen.bmj.com/content/7/1/e000939.full
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author Michael Valente
Henry Ma
Andrew Bivard
Bernard Yan
Mark Parsons
Chushuang Chen
Milanka Visser
author_facet Michael Valente
Henry Ma
Andrew Bivard
Bernard Yan
Mark Parsons
Chushuang Chen
Milanka Visser
author_sort Michael Valente
collection DOAJ
description Vascular territory mapping (VTM) software estimates which intracerebral vessel provides peak arterial flow to a brain voxel. This observational study was performed to assess the hypothesis that the VTM algorithm may correlate to visual measurements of leptomeningeal grading and stroke outcome measures in acute middle cerebral artery (MCA) occlusion. VTM software assigned regions of the brain to an estimated feeding intracerebral vessel. Whole brain dynamic CT angiography was used to visually grade the extent of flow in either anterior or posterior cerebral leptomeningeal arteries. The final dataset included 115 patients with MCA occlusion. The median age was 74 years (IQR 62–82). The time from onset of symptoms to scan was a median of 129 min (IQR 85–241) and the median National Institutes of Health Stroke Scale (NIHSS) was 15 (IQR 12–19). Baseline imaging revealed a median ischaemic core of 19 mL (IQR 6–39) and perfusion lesion of 92 mL (IQR 68–122). Ischaemic core and posterior cerebral artery VTM volume were significantly associated with less robust posterior collateral flow on visual grading. VTM variables were not predictive of anterior collateral grade or stroke outcome measures. There did not appear to be a significant relationship between VTM volumes and visualised leptomeningeal collateral flow direction. The clinical utility and diagnostic value of VTM software in predicting collateral flow patterns remain to be elucidated, and further validation studies are warranted to determine the potential applications in acute stroke assessment.
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spelling doaj-art-018b78aac16e41f489a98f457ebcb9392025-08-20T03:13:18ZengBMJ Publishing GroupBMJ Neurology Open2632-61402025-02-017110.1136/bmjno-2024-000939Validation of CT perfusion-based vascular territory mapping: correlation to visual pial grading and outcome measuresMichael Valente0Henry Ma1Andrew Bivard2Bernard Yan3Mark Parsons4Chushuang Chen5Milanka Visser6Department of Medicine and Neurology, Melbourne Brain Centre, Parkville, Victoria, AustraliaDepartment of Neurology, Monash Health, Melbourne, Victoria, Australia4Melbourne brain centre, Melbourne, VIC, AustraliaThe Royal Melbourne Hospital, Parkville, Victoria, AustraliaLiverpool Hospital, Liverpool, New South Wales, AustraliaDepartment of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia4Melbourne brain centre, Melbourne, VIC, AustraliaVascular territory mapping (VTM) software estimates which intracerebral vessel provides peak arterial flow to a brain voxel. This observational study was performed to assess the hypothesis that the VTM algorithm may correlate to visual measurements of leptomeningeal grading and stroke outcome measures in acute middle cerebral artery (MCA) occlusion. VTM software assigned regions of the brain to an estimated feeding intracerebral vessel. Whole brain dynamic CT angiography was used to visually grade the extent of flow in either anterior or posterior cerebral leptomeningeal arteries. The final dataset included 115 patients with MCA occlusion. The median age was 74 years (IQR 62–82). The time from onset of symptoms to scan was a median of 129 min (IQR 85–241) and the median National Institutes of Health Stroke Scale (NIHSS) was 15 (IQR 12–19). Baseline imaging revealed a median ischaemic core of 19 mL (IQR 6–39) and perfusion lesion of 92 mL (IQR 68–122). Ischaemic core and posterior cerebral artery VTM volume were significantly associated with less robust posterior collateral flow on visual grading. VTM variables were not predictive of anterior collateral grade or stroke outcome measures. There did not appear to be a significant relationship between VTM volumes and visualised leptomeningeal collateral flow direction. The clinical utility and diagnostic value of VTM software in predicting collateral flow patterns remain to be elucidated, and further validation studies are warranted to determine the potential applications in acute stroke assessment.https://neurologyopen.bmj.com/content/7/1/e000939.full
spellingShingle Michael Valente
Henry Ma
Andrew Bivard
Bernard Yan
Mark Parsons
Chushuang Chen
Milanka Visser
Validation of CT perfusion-based vascular territory mapping: correlation to visual pial grading and outcome measures
BMJ Neurology Open
title Validation of CT perfusion-based vascular territory mapping: correlation to visual pial grading and outcome measures
title_full Validation of CT perfusion-based vascular territory mapping: correlation to visual pial grading and outcome measures
title_fullStr Validation of CT perfusion-based vascular territory mapping: correlation to visual pial grading and outcome measures
title_full_unstemmed Validation of CT perfusion-based vascular territory mapping: correlation to visual pial grading and outcome measures
title_short Validation of CT perfusion-based vascular territory mapping: correlation to visual pial grading and outcome measures
title_sort validation of ct perfusion based vascular territory mapping correlation to visual pial grading and outcome measures
url https://neurologyopen.bmj.com/content/7/1/e000939.full
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