Early Prognostication in Non-Reperfused Stroke: Integrating FVH with CT Perfusion for Personalized Management

Background/ObjectivesAcute ischemic stroke (AIS) is the second leading cause of death globally, with outcomes heavily dependent on collateral circulation. This study investigated the prognostic value of integrating fluid-attenuated inversion recovery vascular hyperintensity (FVH) from MRI with CT perfusion (CTP) parameters for personalized management of non-reperfused AIS patients, focusing on the correlation between FVH and CTA-based collateral scores (rLMC, Maas, ASITN/SIR). MethodsWe retrospectively enrolled AIS patients with internal carotid artery/middle cerebral artery stenosis/occlusion who did not receive reperfusion therapy within 72 hours of onset. All patients underwent one-stop CTA-CTP and multimodal MRI to evaluate: FVH scores (based on modified ASPECTS regions), rLMC scores, Maas scores, and ASITN/SIR collateral grading. Spearman analysis assessed correlations between FVH and CTA collateral scores. Univariate and multivariate logistic regression identified independent predictors of 90-day functional outcome (favorable [mRS 0-2] vs. poor [mRS 3-6]), with Receiver operating characteristic (ROC) curves evaluating predictive performance. ResultsThe cohort comprised 112 patients (70 favorable outcomes, 42 poor outcomes). FVH scores showed negative correlation with ASITN/SIR collateral grades (r=-0.432, P<0.001). Compared to the favorable outcome group, the poor outcome group exhibited higher baseline National Institute of Health Stroke Scale (NIHSS) scores, elevated FVH scores, reduced rLMC scores, and lower rCBV values (all P<0.05). Multivariate analysis identified NIHSS score, FVH score, rLMC score, and rCBV as independent predictors of poor outcomes. ROC analysis demonstrated strong predictive performance for: rLMC score (AUC=0.848, 95%CI 0.778-0.919), FVH score (AUC=0.662, 95%CI 0.550-0.774), and rCBV (AUC=0.727, 95%CI 0.631-0.822). ConclusionsMultimodal CT combined with MRI facilitates early AIS diagnosis and collateral assessment. The integration of FVH with CT parameters (rLMC score, rCBV) effectively predicts functional outcomes in AIS patients.