{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T23:12:25Z","timestamp":1793401945606,"version":"4.5.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"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>\n                    <jats:title>Background\/objectives<\/jats:title>\n                    <jats:p>The variability in acute ischemic stroke (AIS) outcomes is closely associated with collateral circulation status. While fluid-attenuated inversion recovery vascular hyperintensity (FVH) and multimodal CT parameters (e.g., rLMC score, rCBV) were associated with 90-day functional outcomes in AIS patients, their combined predictive value and clinical utility warrant further investigation. This study investigates the combined predictive value of FVH and multimodal CT parameters for collateral assessment and prognosis in AIS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively and consecutively enrolled AIS patients with internal carotid artery or middle cerebral artery stenosis\/occlusion who did not receive intravenous thrombolysis or mechanical thrombectomy. All patients underwent one-stop CT angiography\u2013CT perfusion and multimodal MRI within 72\u202fh of symptom onset. Evaluations included 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 indicated the independent predictors of a 90-day functional outcome [favorable (mRS 0\u20132) vs. poor (mRS 3\u20136)], with receiver operating characteristic (ROC) curves evaluating predictive performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort comprised 112 patients (70 favorable outcomes, 42 poor outcomes). FVH scores showed a negative correlation with ASITN\/SIR collateral grades (\n                      <jats:italic>r<\/jats:italic>\n                      =\u202f\u22120.432,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001). 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\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.05). Multivariate analysis indicated that NIHSS score, FVH score, rLMC score, and rCBV were independent predictors of poor outcomes. ROC analysis demonstrated strong predictive performance for rLMC score (AUC\u202f=\u202f0.848, 95%CI 0.778\u20130.919), FVH score (AUC\u202f=\u202f0.662, 95%CI 0.550\u20130.774), and rCBV (AUC\u202f=\u202f0.727, 95%CI 0.631\u20130.822).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Multimodal CT combined with MRI facilitates early AIS diagnosis and collateral assessment. The integration of FVH with CT parameters (rLMC score and rCBV) was associated with the prediction of functional outcomes in AIS patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1688188","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T06:43:24Z","timestamp":1769669004000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Prediction of collateral circulation grading and functional outcomes in acute ischemic stroke using FLAIR vascular hyperintensity combined with multimodal CT parameters"],"prefix":"10.3389","volume":"17","author":[{"given":"Qiushi","family":"Yang","sequence":"first","affiliation":[{"name":"Mudanjiang Medical University","place":["Mudanjiang, Heilongjiang, China"]},{"name":"Department of Radiology, Daqing Oilfield General Hospital","place":["Daqing, Heilongjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanxin","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Radiology, Daqing Oilfield General Hospital","place":["Daqing, Heilongjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Qu","sequence":"additional","affiliation":[{"name":"Mudanjiang Medical University","place":["Mudanjiang, Heilongjiang, China"]},{"name":"Department of Radiology, Daqing Oilfield General Hospital","place":["Daqing, Heilongjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Chen","sequence":"additional","affiliation":[{"name":"Mudanjiang Medical University","place":["Mudanjiang, Heilongjiang, China"]},{"name":"Department of Radiology, Daqing Oilfield General Hospital","place":["Daqing, Heilongjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Sun","sequence":"additional","affiliation":[{"name":"Mudanjiang Medical University","place":["Mudanjiang, Heilongjiang, China"]},{"name":"Department of Radiology, Daqing Oilfield General Hospital","place":["Daqing, Heilongjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Radiology, Daqing Oilfield General Hospital","place":["Daqing, Heilongjiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/s1474-4422(21)00252-0","article-title":"Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: A systematic analysis for the global burden of disease study 2019","volume":"20","year":"2021","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"94491","DOI":"10.4239\/wjd.v16.i3.94491","article-title":"Effects of glycemic indicators on early neurological outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis","volume":"16","author":"Duan","year":"2025","journal-title":"World J Diabetes"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1007\/s12975-025-01340-6","article-title":"Favorable cerebral collateral cascades improve futile recanalization by reducing ischemic Core volume in acute ischemic stroke patients undergoing endovascular treatment","volume":"16","author":"Huang","year":"2025","journal-title":"Transl Stroke Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1016\/s0140-6736(10)60491-6","article-title":"Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials","volume":"375","author":"Lees","year":"2010","journal-title":"Lancet"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e242401","DOI":"10.1148\/radiol.242401","article-title":"Arterial collaterals and endovascular treatment effect in acute ischemic stroke with large infarct: a secondary analysis of the TENSION trial","volume":"314","author":"Winkelmeier","year":"2025","journal-title":"Radiology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2102","DOI":"10.1161\/strokeaha.118.021484","article-title":"Collateral clock is more important than time clock for tissue fate","volume":"49","author":"Vagal","year":"2018","journal-title":"Stroke"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1136\/jnnp.2007.132100","article-title":"Impact of collateral flow on tissue fate in acute ischaemic stroke","volume":"79","author":"Bang","year":"2008","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"667","DOI":"10.3174\/ajnr.A3862","article-title":"The impact of arterial collateralization on outcome after intra-arterial therapy for acute ischemic stroke","volume":"35","author":"Seeta Ramaiah","year":"2014","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1007\/s002340050761","article-title":"Fast FLAIR sequence for detecting major vascular abnormalities during the hyperacute phase of stroke: a comparison with MR angiography","volume":"41","author":"Cosnard","year":"1999","journal-title":"Neuroradiology"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"5436","DOI":"10.1007\/s00330-022-08661-2","article-title":"FLAIR vessel hyperintensities predict functional outcomes in patients with acute ischemic stroke treated with medical therapy","volume":"32","author":"Lyu","year":"2022","journal-title":"Eur Radiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"4123","DOI":"10.21037\/qims-23-1640","article-title":"Correlation of fluid-attenuated inversion recovery sequence vascular hyperintensity in magnetic resonance with collateral circulation and short-term clinical prognosis in acute ischemic stroke","volume":"14","author":"Xin","year":"2024","journal-title":"Quant Imaging Med Surg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1148\/radiol.2020192029","article-title":"Collateral status at single-phase and multiphase CT angiography versus CT perfusion for outcome prediction in anterior circulation acute ischemic stroke","volume":"296","author":"Wang","year":"2020","journal-title":"Radiology"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1528","DOI":"10.1136\/jnnp.2004.059261","article-title":"Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging","volume":"76","author":"Barber","year":"2005","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2042","DOI":"10.3174\/ajnr.A4423","article-title":"Hyperintense vessels on T2-PROPELLER-FLAIR in patients with acute MCA stroke: prediction of arterial stenosis and perfusion abnormality","volume":"36","author":"Ahn","year":"2015","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"3001","DOI":"10.1161\/strokeaha.109.552513","article-title":"Collateral vessels on CT angiography predict outcome in acute ischemic stroke","volume":"40","author":"Maas","year":"2009","journal-title":"Stroke"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1640","DOI":"10.3174\/ajnr.A2564","article-title":"Regional leptomeningeal score on CT angiography predicts clinical and imaging outcomes in patients with acute anterior circulation occlusions","volume":"32","author":"Menon","year":"2011","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e109","DOI":"10.1161\/01.Str.0000082721.62796.09","article-title":"Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke","volume":"34","author":"Higashida","year":"2003","journal-title":"Stroke"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1056\/NEJMoa0804656","article-title":"Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke","volume":"359","author":"Hacke","year":"2008","journal-title":"N Engl J Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1136\/svn-2019-000321","article-title":"Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of stroke rehabilitation","volume":"5","author":"Zhang","year":"2020","journal-title":"Stroke Vasc Neurol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1148\/radiol.2019181510","article-title":"Acute stroke: prognostic value of quantitative collateral assessment at perfusion CT","volume":"290","author":"Shi","year":"2019","journal-title":"Radiology"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2797","DOI":"10.1016\/j.jstrokecerebrovasdis.2018.06.010","article-title":"The prognostic value of CT-angiographic parameters after reperfusion therapy in acute ischemic stroke patients with internal carotid artery terminus occlusion: leptomeningeal collateral status and clot burden score","volume":"27","author":"Park","year":"2018","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1161\/strokeaha.122.040008","article-title":"Large vessel occlusion stroke due to intracranial atherosclerotic disease: identification, medical and interventional treatment, and outcomes","volume":"54","author":"de Havenon","year":"2023","journal-title":"Stroke"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1002\/ana.24211","article-title":"A novel magnetic resonance imaging approach to collateral flow imaging in ischemic stroke","volume":"76","author":"Kim","year":"2014","journal-title":"Ann Neurol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"346","DOI":"10.3389\/fneur.2019.00346","article-title":"Postreperfusion blood pressure variability after endovascular Thrombectomy affects outcomes in acute ischemic stroke patients with poor collateral circulation","volume":"10","author":"Chang","year":"2019","journal-title":"Front Neurol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"8067","DOI":"10.1007\/s00330-022-08886-1","article-title":"Prognostic value of post-treatment fluid-attenuated inversion recovery vascular hyperintensity in ischemic stroke after endovascular thrombectomy","volume":"32","author":"Xu","year":"2022","journal-title":"Eur Radiol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"808436","DOI":"10.3389\/fnins.2021.808436","article-title":"Fluid-attenuated inversion recovery vascular Hyperintensity as a potential predictor for the prognosis of acute stroke patients after intravenous thrombolysis","volume":"15","author":"Zhu","year":"2021","journal-title":"Front Neurosci"},{"key":"ref27","first-page":"367","article-title":"Using the National Institutes of Health stroke scale (NIHSS) to predict the mortality and outcome of patients with intracerebral haemorrhage","volume":"14","author":"Cheung","year":"2008","journal-title":"Hong Kong Med J"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1007\/s00062-019-00803-2","article-title":"Correction to: accuracy and reliability of multiphase CTA perfusion for identifying ischemic Core","volume":"29","author":"Reid","year":"2019","journal-title":"Clin Neuroradiol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2465","DOI":"10.1161\/strokeaha.121.034620","article-title":"Thomas Willis lecture: targeting brain arterioles for acute stroke treatment","volume":"52","author":"Cipolla","year":"2021","journal-title":"Stroke"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1016\/j.neurad.2021.01.009","article-title":"Interpretation of fluid-attenuated inversion recovery vascular hyperintensity in stroke","volume":"49","author":"Lee","year":"2022","journal-title":"J Neuroradiol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"4879","DOI":"10.1007\/s00330-019-06022-0","article-title":"FLAIR vascular hyperintensity in acute stroke is associated with collateralization and functional outcome","volume":"29","author":"Jiang","year":"2019","journal-title":"Eur Radiol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1007\/s10072-019-03909-0","article-title":"Fluid-attenuated inversion recovery vascular hyperintensities in anterior circulation acute ischemic stroke: associations with cortical brain infarct volume and 90-day prognosis","volume":"40","author":"Dong","year":"2019","journal-title":"Neurol Sci"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1161\/strokeaha.117.019588","article-title":"Hyperintense vessels, collateralization, and functional outcome in patients with stroke receiving endovascular treatment","volume":"49","author":"Nave","year":"2018","journal-title":"Stroke"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"647","DOI":"10.19300\/j.2017.L5734zt","article-title":"Fluid-attenuated inversion recovery vascular hyperintensities and acute ischemic stroke outcome","volume":"40","author":"Jing","year":"2017","journal-title":"Int J Med Radiol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"2683","DOI":"10.1161\/strokeaha.114.006163","article-title":"Computed tomographic angiography and cerebral blood volume can predict final infarct volume and outcome after recanalization","volume":"45","author":"Lum","year":"2014","journal-title":"Stroke"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"2409","DOI":"10.1161\/strokeaha.124.047483","article-title":"Decreased quantitative cerebral blood volume is associated with poor outcomes in large Core patients","volume":"55","author":"Yedavalli","year":"2024","journal-title":"Stroke"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e039924","DOI":"10.1161\/jaha.124.039924","article-title":"Prolonged venous transit as a superior predictor of functional outcomes in successfully Reperfused large vessel occlusions: comparative analysis with cerebral blood volume index and Hypoperfusion intensity ratio","volume":"14","author":"Mei","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"3389","DOI":"10.1007\/s00415-024-12279-3","article-title":"Follow-up infarct volume on fluid attenuated inversion recovery (FLAIR) imaging in distal medium vessel occlusions: the role of cerebral blood volume index","volume":"271","author":"Salim","year":"2024","journal-title":"J Neurol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1839","DOI":"10.1177\/0271678x17740293","article-title":"Relative cerebral blood volume is associated with collateral status and infarct growth in stroke patients in SWIFT PRIME","volume":"38","author":"Arenillas","year":"2018","journal-title":"J Cereb Blood Flow Metab"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1136\/neurintsurg-2014-011279","article-title":"Correlation between cerebral blood volume values and outcomes in endovascular therapy for acute ischemic stroke","volume":"7","author":"Mokin","year":"2015","journal-title":"J Neurointerv Surg"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1688188\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:26:16Z","timestamp":1771925176000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1688188\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":40,"alternative-id":["10.3389\/fneur.2026.1688188"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1688188","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]},"article-number":"1688188"}}