血管内取栓再通自动定量评估新方法
基于295例急性缺血性卒中患者的前瞻性队列，研究开发了从DSA图像自动提取血管形态和灌注指标并计算定量TICI（qTICI）评分的流程。qTICI与专家判定的eTICI分级中度一致（AUC 0.70），但在预测成功再通患者的72小时NIHSS和90天mRS方面优于eTICI。自动化qTICI有望成为客观的再通评估替代工具。
要点
- qTICI自动整合血管形态、拓扑和灌注动力学，提供数值化再灌注指标。
- qTICI与eTICI中度一致，但在预测临床结局上优于eTICI。
- qTICI联合临床变量可进一步提升预测性能。
核心结论
- 自动化qTICI评分提供客观的再通评估，对急性缺血性卒中结局的预测准确性较eTICI有适度提升。
- 需前瞻性多中心验证以标准化再灌注评估并支持qTICI融入临床试验和卒中诊疗。
研究设计与样本
- 前瞻性收集295例接受血管内取栓的急性缺血性卒中患者队列。
- 从再通后DSA图像自动提取血管形态和灌注指标，计算qTICI。
- 以专家介入神经放射科医生判定的扩展TICI（eTICI）分级为参考标准。
诊断标准与关键数值
- qTICI与eTICI分级中度一致，微平均AUC为0.70。
- 在成功再通患者中，qTICI预测72小时NIHSS的AUC为0.60（eTICI为0.47），预测90天mRS的AUC为0.55（eTICI为0.46）。
- qTICI联合额外临床变量可进一步提升预测性能。
- 多变量分析显示qTICI对结局预测的贡献大于eTICI。
临床应用与阅片要点
- qTICI可作为客观的再通评估工具，辅助减少视觉eTICI判定的观察者间变异。
- 在报告成功再通时，可考虑结合qTICI数值与临床变量综合评估预后。
局限性
- 研究为单中心前瞻性队列，需多中心外部验证。
- qTICI与eTICI仅呈中度一致，预测准确性的提升幅度有限。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND: Acute ischemic stroke (AIS) remains a major cause of death and disability worldwide. Endovascular thrombectomy (EVT) has significantly improved outcomes by restoring cerebral blood flow. The thrombolysis in cerebral infarction (TICI) score, the current standard for recanalization assessment, is a semi-quantitative grading system that is commonly used to evaluate the effectiveness of thrombectomy, but it suffers from inter-rater variability and is poorly correlated with clinical outcomes. Here, we propose a novel and fully automated quantitative TICI (qTICI) score derived from digital subtraction angiography (DSA) during EVT that integrates morphological descriptors, vascular network topology, and perfusion dynamics to provide a numeric quantitative reperfusion metric.
METHODS: Using a prospectively collected cohort of 295 AIS patients who underwent EVT, we developed an automated pipeline to extract vascular morphology and perfusion metrics from post-recanalization DSA images. We integrated selected features to compute qTICI and evaluated its performance against adjudicated extended TICI (eTICI) grades, provided by expert interventional neuroradiologists, to predict clinical outcomes.
RESULTS: While the qTICI score demonstrated moderate agreement with the eTICI grades (micro-average AUC 0.70), it outperformed eTICI in predicting both early and long-term outcomes among successfully recanalized patients (72-hour NIHSS: AUC 0.60 vs 0.47; 90-day mRS: AUC 0.55 vs 0.46). Combining qTICI with additional clinical variables further enhanced its predictive performance. Multivariable analyses showed a greater contribution of qTICI to outcome predictions, compared with eTICI.
CONCLUSIONS: These findings indicate that automated qTICI offers an objective and enhanced alternative to visual grading with modest improvements in prognostic accuracy for AIS outcomes. Prospective, multi-center validation is warranted to standardize reperfusion assessment and support integration of qTICI into clinical trials and stroke care.
引用
- Ebrahimzadeh MA, Deshpande A, Wang J, et al. Automated Quantitative Assessment of Recanalization in Endovascular Thrombectomy. AJNR Am J Neuroradiol. 2026. PMID: 42217840. doi:10.3174/ajnr.A9440
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。