BACKGROUND The Thrombolysis in Cerebral Infarction (TICI) scale is an important outcome measure to evaluate the quality of endovascular stroke therapy. The TICI scale is ordinal and observer-dependent, which may result in suboptimal prediction of patient outcome and inconsistent reperfusion grading. AIMS We present a semi-automated quantitative reperfusion measure (quantified TICI (qTICI)) using image processing techniques based on the TICI methodology. METHODS We included patients with an intracranial proximal large vessel occlusion with complete, good quality runs of anteroposterior and lateral digital subtraction angiography from the MR CLEAN Registry. For each vessel occlusion, we identified the target downstream territory and automatically segmented the reperfused area in the target downstream territory on final digital subtraction angiography. qTICI was defined as the percentage of reperfused area in target downstream territory. The value of qTICI and extended TICI (eTICI) in predicting favorable functional outcome (modified Rankin Scale 0-2) was compared using area under receiver operating characteristics curve and binary logistic regression analysis unadjusted and adjusted for known prognostic factors. RESULTS In total, 408 patients with M1 or internal carotid artery occlusion were included. The median qTICI was 78 (interquartile range 58-88) and 215 patients (53%) had an eTICI of 2C or higher. qTICI was comparable to eTICI in predicting favorable outcome with area under receiver operating characteristics curve of 0.63 vs. 0.62 (P = 0.8) and 0.87 vs. 0.86 (P = 0.87), for the unadjusted and adjusted analysis, respectively. In the adjusted regression analyses, both qTICI and eTICI were independently associated with functional outcome. CONCLUSION qTICI provides a quantitative measure of reperfusion with similar prognostic value for functional outcome to eTICI score.

中文翻译：

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qTICI：急性缺血性卒中患者数字减影血管造影的脑组织再灌注定量评估。

背景 脑梗死溶栓 (TICI) 量表是评估血管内卒中治疗质量的重要结果指标。TICI 量表是有序的且依赖于观察者，这可能会导致对患者结果的预测不佳和再灌注分级不一致。目的 我们使用基于 TICI 方法的图像处理技术提出了一种半自动定量再灌注测量（定量 TICI (qTICI)）。方法 我们纳入了颅内近端大血管闭塞的患者，并从 MR CLEAN Registry 进行了完整、高质量的前后位和侧位数字减影血管造影。对于每个血管闭塞，我们识别了目标下游区域，并在最终的数字减影血管造影中自动分割了目标下游区域中的再灌注区域。qTICI 定义为目标下游区域再灌注区域的百分比。使用接受者操作特征曲线下面积和未调整和调整已知预后因素的二元逻辑回归分析比较了 qTICI 和扩展 TICI (eTICI) 在预测有利功能结果（改良 Rankin 量表 0-2）方面的价值。结果共纳入408例M1或颈内动脉闭塞患者。中位 qTICI 为 78（四分位距 58-88），215 名患者（53%）的 eTICI 为 2C 或更高。对于未调整和调整的分析，qTICI 在预测有利结果方面与 eTICI 相当，受试者操作特征曲线下面积分别为 0.63 对 0.62（P = 0.8）和 0.87 对 0.86（P = 0.87）。在调整后的回归分析中，qTICI 和 eTICI 均与功能结果独立相关。结论 qTICI 提供了再灌注的定量测量，对功能结果具有与 eTICI 评分相似的预后价值。