Deans' stroke musings: Quantitative insights into stroke recovery utilizing delayed vessel ratio from color-coded multiphase computed tomography angiography

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, June 19, 2025

Quantitative insights into stroke recovery utilizing delayed vessel ratio from color-coded multiphase computed tomography angiography

Predicting recovery is totally fucking useless. DELIVER EXACT RECOVERY PROTOCOLS! I'd fire anyone doing prediction research, it's useless!

Quantitative insights into stroke recovery utilizing delayed vessel ratio from color-coded multiphase computed tomography angiography

Yu Lin^1,2,3†, Xiaoxiao Zhang^2†, Zhen Xing¹, Xiefeng Yang¹, Qingwen Tong⁴, Shaomao Lv², Jinan Wang^2,3 and Dairong Cao^1,5,6,7*

¹Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China

²Department of Radiology, Zhongshan Hospital Affiliated to Xiamen University, School of Clinical Medicine of Fujian Medical University, Xiamen, China

³Xiamen Radiology Quality Control Center, Zhongshan Hospital Affiliated to Xiamen University, School of Clinical Medicine of Fujian Medical University, Xiamen, China

⁴Department of Health Examination, Xiamen Humanity Hospital Fujian Medical University, Xiamen, China

⁵Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital of Fujian Medical University, Fuzhou, China

⁶Fujian Provincial Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China

⁷Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China

Edited by
Alan Wang, The University of Auckland, New Zealand

Reviewed by
Rodrigo Assar, University of Chile, Chile
Jihoon Kang, Seoul National University Bundang Hospital, Republic of Korea

*Correspondence
Dairong Cao, dairongcao@163.com

^†These authors have contributed equally to this work and share first authorship

Received 30 January 2025
Accepted 03 June 2025
Published 18 June 2025

Citation
Lin Y, Zhang X, Xing Z, Yang X, Tong Q, Lv S, Wang J and Cao D (2025) Quantitative insights into stroke recovery utilizing delayed vessel ratio from color-coded multiphase computed tomography angiography. Front. Neurol. 16:1568717. doi: 10.3389/fneur.2025.1568717

Background and objective:

The color-coded multiphase computed tomography angiography (cmCTA) is an accredited technique that employs color-coding to visually depict the temporal dynamics of collateral blood flow in patients with acute ischemic stroke (AIS). This research aimed to assess the quantification of cmCTA in AIS patients for characterizing arterial and venous collateral flow, and predicting functional outcomes.

Methods:

A retrospective study was performed on a consecutive cohort of AIS patients with large vessel occlusion who underwent cmCTA scan and reconstruction. Collateral ratio and delayed vessel ratio (DVR) were determined through semi-automatic delineation and calculation on the anterior cerebral artery regions and Alberta Stroke Program Early CT (ASPECT) Score regions of cmCTA maps. Deep venous outflow (DVO) and superficial venous outflow (SVO) scores were assessed using a 6-point scale. Logistic regression and propensity score were applied to confounding factors adjustment and model construction. Receiver operating characteristic curve, calibration curve, and decision curve analysis were utilized to evaluate the prediction model of functional independence and excellent recovery.

Results:

Well-developed arterial collaterals as depicted by low DVR and adequate venous collaterals as indicated by high DVO or SVO were correlated with better outcomes (All p < 0.001). Adjusted DVR showed areas under the curve of 0.81–0.90 for predicting functional independence and excellent recovery. Adjusted DVO showed areas under the curve of 0.88 for predicting functional independence and excellent recovery. Each prediction model demonstrated good precision and net benefit.

Conclusion:

The application of DVR and other parameters in cmCTA offers a quantitative perspective on the conventional ASPECT scoring scheme utilizing grayscale CT images. DVR from cmCTA may enhance pre-treatment collateral assessment and post-treatment outcome prediction in AIS, facilitating informed treatment decisions.