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Time-dependent parameter of perfusion imaging as independent predictor of clinical outcome in symptomatic carotid artery stenosis

Overview of attention for article published in BMC Neurology, April 2016
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Time-dependent parameter of perfusion imaging as independent predictor of clinical outcome in symptomatic carotid artery stenosis
Published in
BMC Neurology, April 2016
DOI 10.1186/s12883-016-0576-5
Pubmed ID

Sibu Mundiyanapurath, Peter Arthur Ringleb, Sascha Diatschuk, Oliver Eidel, Sina Burth, Ralf Floca, Markus Möhlenbruch, Wolfgang Wick, Martin Bendszus, Alexander Radbruch


Carotid artery stenosis is a frequent cause of ischemic stroke. While any degree of stenosis can cause embolic stroke, a higher degree of stenosis can also cause hemodynamic infarction. The hemodynamic effect of a stenosis can be assessed via perfusion weighted MRI (PWI). Our aim was to investigate the ability of PWI-derived parameters such as TTP (time-to-peak) and Tmax (time to the peak of the residue curve) to predict outcome in patients with unilateral acute symptomatic internal carotid artery (sICA) stenosis. Patients with unilateral acute sICA stenosis (≥50 % according to NASCET), without intracranial stenosis or occlusion, who underwent PWI, were included. Clinical characteristics, volume of restricted diffusion, volume of prolonged TTP and Tmax were retrospectively analyzed and correlated with outcome represented by the modified Rankin Scale (mRS) score at discharge. TTP and Tmax volumes were dichotomized using a ROC curve analysis. Multivariate analysis was performed to determine which PWI-parameter was an independent predictor of outcome. Thirty-two patients were included. Degree of stenosis, volume of visually assessed TTP and volume of TTP ≥2 s did not distinguish patients with favorable (mRS 0-2) and unfavorable (mRS 3-6) outcome. In contrast, patients with unfavorable outcome had higher volumes of TTP ≥4 s (9.12 vs. 0.87 ml; p = 0.043), TTP ≥6 s (6.70 vs. 0.20 ml; p = 0.017), Tmax ≥4 s (25.27 vs. 0.00 ml; p = 0.043), Tmax ≥6 s (9.21 vs. 0.00 ml; p = 0.017), Tmax ≥8 s (6.86 vs. 0.00 ml; p = 0.011) and Tmax ≥10s (5.94 vs. 0.00 ml; p = 0.025) in univariate analysis. Multivariate logistic regression showed that NIHSS score on admission (Odds Ratio (OR) 0.466, confidence interval (CI) [0.224;0.971], p = 0.041), Tmax ≥8 s (OR 0.025, CI [0.001;0.898] p = 0.043) and TTP ≥6 s (OR 0.025, CI [0.001;0.898] p = 0.043) were independent predictors of clinical outcome. As they stood out in multivariate regression and are objective and reproducible parameters, PWI-derived volumes of Tmax ≥8 s and TTP ≥6 s might be superior to degree of stenosis and visually assessed TTP maps in predicting short term patient outcome. Future studies should assess if perfusion weighted imaging might guide the selection of patients for recanalization procedures.

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Mendeley readers

The data shown below were compiled from readership statistics for 18 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 18 100%

Demographic breakdown

Readers by professional status Count As %
Researcher 4 22%
Student > Ph. D. Student 3 17%
Student > Doctoral Student 2 11%
Student > Bachelor 2 11%
Other 1 6%
Other 1 6%
Unknown 5 28%
Readers by discipline Count As %
Medicine and Dentistry 7 39%
Arts and Humanities 1 6%
Computer Science 1 6%
Neuroscience 1 6%
Chemistry 1 6%
Other 1 6%
Unknown 6 33%