Assessment of Collateral Flow with Multi-Phasic CT: Correlation with Diffusion Weighted MRI in MCA Occlusion

PURPOSE To correlate collateral flow on multiphasic contrast enhancement computed tomography (CT) and graded ischemic changes on diffusion weighted MR in patients with acute middle cerebral artery (MCA) infarction. MATERIALS AND METHODS A retrospective evaluation of diffusion weighted images (DWIs) and three phasic contrast enhanced CT (CECT) was performed on 11 patients with MCA occlusions. The area of ischemic change on DWIs was graded according to the Alberta Stroke Program Early CT Score (ASPECTS) criteria. To evaluate collateral flow on three phasic CECT, we counted the number of contrast enhancing MCA branches distal to the occlusion site at the sylvian fissure from predetermined axial images. The collateral ratios of counted numbers to those at the normal side were calculated at each phase (CR1, CR2, CR3). We then compared collateral ratios from the three phasic CECT with ASPECTS data from DWIs. RESULTS Collateral ratios from the three phasic CECT were determined to be CR1 .48 +/- .27, CR2 .73 +/- .36 and CR3 .72 +/- .30. We discovered a correlation between both the CR2 and ASPECTS (r = .675, P = .023) and the CR3 and ASPECTS (r = .664, P = .026). CONCLUSION The number of contrast enhancing branches distal to the MCA occlusion, as counted in the sylvian fissure on later phase images of multiphasic CECT, reflects the status of collateral flow, and correlates with ASPECTS on DWIs.