Cerebral Hypoperfusion Intensity Ratio Is Linked to Progressive Early Edema Formation

The hypoperfusion intensity ratio (HIR) is associated with collateral status and reflects the impaired microperfusion of brain tissue in patients with acute ischemic stroke and large vessel occlusion (AIS-LVO). As a deterioration in cerebral blood flow is associated with brain edema, we aimed to investigate whether HIR is correlated with the early edema progression rate (EPR) determined by the ischemic net water uptake (NWU) in a multicenter retrospective analysis of AIS-LVO patients anticipated for thrombectomy treatment. HIR was automatically calculated as the ratio of time-to-maximum (TMax) > 10 s/(TMax) > 6 s. HIRs < 0.4 were regarded as favorable (HIR+) and >= 0.4 as unfavorable (HIR-). Quantitative ischemic lesion NWU was delineated on baseline NCCT images and EPR was calculated as the ratio of NWU/time from symptom onset to imaging. Multivariable regression analysis was used to assess the association of HIR with EPR. This study included 731 patients. HIR+ patients exhibited a reduced median NWU upon admission CT (4% (IQR: 2.1-7.6) versus 8.2% (6-10.4); p < 0.001) and less median EPR (0.016%/h (IQR: 0.007-0.04) versus 0.044%/h (IQR: 0.021-0.089; p < 0.001) compared to HIR- patients. Multivariable regression showed that HIR+ (beta: 0.53, SE: 0.02; p = 0.003) and presentation of the National Institutes of Health Stroke Scale (beta: 0.2, SE: 0.0006; p = 0.001) were independently associated with EPR. In conclusion, favorable HIR was associated with lower early edema progression and decreased ischemic edema formation on baseline NCCT.