{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T01:25:40Z","timestamp":1768008340392,"version":"3.49.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aims to introduce a novel non-invasive imaging method, 3D multi-inversion time arterial spin labeling (3D mTI-ASL), for grading collateral circulation in patients with acute ischemic stroke (AIS) and to compare its effectiveness with digital subtraction angiography (DSA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed data from 28 patients with unilateral internal carotid artery or middle cerebral artery occlusion who underwent both DSA and 3D mTI-ASL imaging before endovascular treatment. A post-processing pipeline was established to grade collateral flow based on 16 perfusion-weighted images. The agreement between the collateral grades derived from ASL and DSA was evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Strong interobserver agreement was observed for both DSA (<jats:italic>\u03ba<\/jats:italic>\u202f=\u202f0.856) and mTI-ASL (<jats:italic>\u03ba<\/jats:italic>\u202f=\u202f0.849). A moderate level of consistency in collateral grading between 3D mTI-ASL and DSA was noted (<jats:italic>\u03ba<\/jats:italic>\u202f=\u202f0.568, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). This was improved when patients were categorized into poor and good collateral groups within both grading systems (<jats:italic>k<\/jats:italic>\u202f=\u202f0.781, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). Notably, patients with good collaterals (Grades 3\u20134) had significantly lower admission National Institutes of Health Stroke Scale scores compared to patients with poor collaterals (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.028 for DSA and <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.015 for mTI-ASL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The 3D mTI-ASL technique shows promise as a reliable, non-invasive method for assessing collateral circulation in AIS. By simulating DSA-derived grading, it may serve as a complementary tool in clinical decision-making for acute stroke management.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1553216","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T04:10:39Z","timestamp":1756440639000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Dynamically grading cerebral collateral circulation using 3D multi-inversion time arterial spin labeling in ischemic stroke: a comparison with digital subtraction angiography"],"prefix":"10.3389","volume":"16","author":[{"given":"Chuili","family":"Kong","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quanzhi","family":"Feng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiantian","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuwang","family":"Qiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xianchang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josef","family":"Pfeuffer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tong","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/S1474-4422(24)00369-7","article-title":"Global, 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