Share this content in WeChat
Clinical Article
Application value of TWIST technique in evaluating collateral circulation in acute ischemic stroke
WANG Siyu  AI Zhongping  WU Qianqian  JIANG Hailong  JIANG Liang  CHEN Guozhong  YIN Xindao 

Cite this article as: Wang SY, Ai ZP, Wu QQ, et al. Application value of TWIST technique in evaluating collateral circulation in acute ischemic stroke[J]. Chin J Magn Reson Imaging, 2022, 13(5): 11-16. DOI:10.12015/issn.1674-8034.2022.05.003.

[Abstract] Objective To evaluate the value of time-resolved with interleaved stochastic trajectories (TWIST) technology in the evaluation of collateral circulation in acute ischemic stroke.Materials and Methods The general clinical data of 28 patients with acute ischemic stroke treated in the Department of Neurology of Nanjing First Hospital from August 2020 to August 2021 were analyzed retrospectively. All patients underwent TWIST, perfusion weighted imaging and digital subtraction angiography (DSA). The collateral circulation classification of DSA and TWIST images refer to the classification system of American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) and the modified ASITN/SIR score scale, respectively. Kappa coefficient was used to analyze the consistency of collateral circulation classification among different observers. χ2 test was used to analyze the inter group differences of collateral circulation classification results of TWIST and DSA images. The patients were divided into abundant collateral circulation group and insufficient collateral circulation group according to the collateral circulation classification of TWIST images, ASITN/SIR score 3-4 indicates abundant collateral circulation and score 0-2 indicates insufficient collateral circulation. The clinical data and hypoperfusion intensity ratio (HIR) of the two groups were compared. Spearman rank correlation coefficient was used to analyze the correlation between HIR and collateral circulation classification of TWIST images.Results The collateral circulation scores of TWIST (Kappa=0.826) and DSA (Kappa=0.856) images were both highly consistent among different observers. There was no significant difference in collateral circulation classification between TWIST and DSA images (χ2=0.865, P=0.929). The HIR in the abundant collateral circulation group (15 cases) was lower than that in the insufficient collateral circulation group (13 cases) (0.30±0.08 vs. 0.43±0.06, t=-5.156, P<0.001). Correlation analysis showed that HIR was negatively correlated with the classification of collateral circulation in TWIST images (r=-0.882, P<0.001).Conclusions Magnetic resonance TWIST can noninvasive evaluate collateral circulation of acute ischemic stroke. It has high value in collateral circulation diagnosis and can be used in clinic.
[Keywords] acute ischemic stroke;magnetic resonance imaging;time-resolved angiography with interleaved stochastic trajectories;collateral circulation;hypoperfusion intensity ratio

WANG Siyu1   AI Zhongping1   WU Qianqian2   JIANG Hailong1   JIANG Liang1   CHEN Guozhong1   YIN Xindao1*  

1 Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

2 Clinical Medical Engineering Office, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China

YIN XD, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS National Natural Science Foundation of China (No. 82001811); Natural Science Foundation of Jiangsu Province (No. BK20201118).
Received  2021-10-27
Accepted  2022-04-29
DOI: 10.12015/issn.1674-8034.2022.05.003
Cite this article as: Wang SY, Ai ZP, Wu QQ, et al. Application value of TWIST technique in evaluating collateral circulation in acute ischemic stroke[J]. Chin J Magn Reson Imaging, 2022, 13(5): 11-16. DOI:10.12015/issn.1674-8034.2022.05.003.

Patel RAG, McMullen PW. Neuroprotection in the treatment of acute ischemic stroke[J]. Prog Cardiovasc Dis, 2017, 59(6): 542-548. DOI: 10.1016/j.pcad.2017.04.005.
Lees KR, Emberson J, Blackwell L, et al. Effects of alteplase for acute stroke on the distribution of functional outcomes: a pooled analysis of 9 trials[J]. Stroke, 2016, 47(9): 2373-2379. DOI: 10.1161/STROKEAHA.116.013644.
Liu Y, Zhu L, Hou B, et al. Study on the correlation between the circle of Willis structure and collateral circulation in bilateral carotid artery occlusion[J]. Neurol Sci, 2021, 42(12): 5335-5342. DOI: 10.1007/s10072-021-05265-4.
Shen M, Wei GR, Cheng M, et al. Association between enlarged perivascular spaces and internal carotid artery stenosis: a study in patients diagnosed by digital subtraction angiography[J]. J Stroke Cerebrovasc Dis, 2020, 29(4): 104635. DOI: 10.1016/j.jstrokecerebrovasdis.2019.104635.
Ghibes P, Hefferman G, Nikolaou K, et al. Quantitative evaluation of peripheral arterial blood flow using peri-interventional fluoroscopic parameters: an in vivo study evaluating feasibility and clinical utility[J]. Biomed Res Int, 2020, 2020: 9526790. DOI: 10.1155/2020/9526790.
Lee SJ, Liu B, Rane N, et al. Correlation between CT angiography and digital subtraction angiography in acute ischemic strokes[J]. Clin Neurol Neurosurg, 2021, 200: 106399. DOI: 10.1016/j.clineuro.2020.106399.
Raczeck P, Fries P, Massmann A, et al. Diagnostic performance of a lower-dose contrast-enhanced 4D dynamic MR angiography of the lower extremities at 3 T using multisegmental time-resolved maximum intensity projections[J]. J Magn Reson Imaging, 2021, 54(3): 763-774. DOI: 10.1002/jmri.27631.
Bani-Sadr A, Aguilera M, Cappucci M, et al. Comparison of magnetic resonance angiography techniques to brain digital subtraction arteriography in the setting of mechanical thrombectomy: a non-inferiority study[J]. Rev Neurol (Paris), 2022: S0035-S3787(22)00040-6. DOI: 10.1016/j.neurol.2021.12.009.
Dhundass S, Savatovsky J, Duron L, et al. Improved detection and characterization of arterial occlusion in acute ischemic stroke using Contrast Enhanced MRA[J]. J De Neuroradiol, 2020; 47(4): 278-283. DOI: 10.1016/j.neurad.2019.02.011.
Grossberg JA, Howard BM, Saindane AM. The use of contrast-enhanced, time-resolved magnetic resonance angiography in cerebrovascular pathology[J]. Neurosurg Focus, 2019, 47(6): E3. DOI: 10.3171/2019.9.FOCUS19627.
Yokota Y, Fushimi Y, Okada T, et al. Evaluation of image quality of pituitary dynamic contrast-enhanced MRI using time-resolved angiography with interleaved stochastic trajectories (TWIST) and iterative reconstruction TWIST (IT-TWIST)[J]. J Magn Reson Imaging, 2020, 51(5): 1497-1506. DOI: 10.1002/jmri.26962.
Sugrue G, Cradock A, McGee A, et al. Subtraction of time-resolved magnetic resonance angiography images improves visualization of the pulmonary veins and left atrium in adults with congenital heart disease: a novel post-processing technique[J]. Int J Cardiovasc Imaging, 2019, 35(7): 1339-1346. DOI: 10.1007/s10554-019-01585-x.
Sia PI, Curragh D, Patel S, et al. Time-resolved three-dimensional technique for dynamic magnetic resonance dacryocystography[J]. Clin Exp Ophthalmol, 2019, 47(9): 1131-1137. DOI: 10.1111/ceo.13618.
Seeger A, Klose U, Poli S, et al. Acute stroke imaging: feasibility and value of MR angiography with high spatial and temporal resolution for vessel assessment and perfusion analysis in patients with wake-up stroke[J]. Acad Radiol, 2015, 22(4): 413-422. DOI: 10.1016/j.acra.2014.11.013.
Le Bras A, Raoult H, Ferré JC, et al. Optimal MRI sequence for identifying occlusion location in acute stroke: which value of time-resolved contrast-enhanced MRA?[J]. AJNR Am J Neuroradiol, 2015, 36(6): 1081-1088. DOI: 10.3174/ajnr.A4264.
Roh HG, Kim EY, Kim IS, et al. A novel collateral imaging method derived from time-resolved dynamic contrast-enhanced MR angiography in acute ischemic stroke: a pilot study[J]. AJNR Am J Neuroradiol, 2019, 40(6): 946-953. DOI: 10.3174/ajnr.A6068.
Guenego A, Marcellus DG, Martin BW, et al. Hypoperfusion intensity ratio is correlated with patient eligibility for thrombectomy[J]. Stroke, 2019, 50(4): 917-922. DOI: 10.1161/STROKEAHA.118.024134.
Ben Hassen W, Malley C, Boulouis G, et al. Inter- and intraobserver reliability for angiographic leptomeningeal collateral flow assessment by the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale[J]. J Neurointerv Surg, 2019, 11(4): 338-341. DOI: 10.1136/neurintsurg-2018-014185.
Hernández-Pérez M, Puig J, Blasco G, et al. Dynamic magnetic resonance angiography provides collateral circulation and hemodynamic information in acute ischemic stroke[J]. Stroke, 2016, 47(2): 531-534. DOI: 10.1161/STROKEAHA.115.010748.
Xu HB, Shen XC, Ji YG, et al. The study on the correlation between FLAIR vascular hyperintensities and hypoperfusion intensity ratio in acute ischemic stroke[J]. J Clin Radiol, 2020, 39(11): 2175-2180. DOI: 10.13437/j.cnki.jcr.2020.11.009.
Cha E, Kim EY, Ye JC. K-space deep learning for parallel MRI: application to time-resolved MR angiography[EB/OL]. 2018: 1-11. (2018-06-10)[2021-10-27].
Wetzl J, Forman C, Wintersperger BJ, et al. High-resolution dynamic CE-MRA of the thorax enabled by iterative TWIST reconstruction[J]. Magn Reson Med, 2017, 77(2): 833-840. DOI: 10.1002/mrm.26146.
Gratz M, Schlamann M, Goericke S, et al. Evaluation of fast highly undersampled contrast-enhanced MR angiography (sparse CE-MRA) in intracranial applications-initial study[J]. Eur Radiol, 2017, 27(3): 1004-1011. DOI: 10.1007/s00330-016-4398-z.
Higgins LJ, Koshy J, Mitchell SE, et al. Time-resolved contrast-enhanced MRA (TWIST) with gadofosveset trisodium in the classification of soft-tissue vascular anomalies in the head and neck in children following updated 2014 ISSVA classification: first report on systematic evaluation of MRI and TWIST in a cohort of 47 children[J]. Clin Radiol, 2016, 71(1): 32-39. DOI: 10.1016/j.crad.2015.09.006.
Chandrashekhara SH, Gulati GS, Sharma S, et al. Comparison between time-resolved magnetic resonance angiography and diagnostic digital subtraction angiography in the vascular assessment of nonspecific aorto-arteritis patients: a prospective study[J]. Vasc Endovascular Surg, 2021, 55(6): 586-592. DOI: 10.1177/15385744211010593.
Parmar H, Ivancevic MK, Dudek N, et al. Dynamic MRA with four-dimensional time-resolved angiography using keyhole at 3 tesla in head and neck vascular lesions[J]. J Neuroophthalmol, 2009, 29(2): 119-127. DOI: 10.1097/WNO.0b013e3181a58c20.
Monteiro A, Cortez GM, Greco E, et al. Hypoperfusion intensity ratio for refinement of elderly patient selection for endovascular thrombectomy[J]. J Neurointerv Surg, 2022, 14(3): 242-247. DOI: 10.1136/neurintsurg-2020-017218.
Wang CM, Chang YM, Sung PS, et al. Hypoperfusion index ratio as a surrogate of collateral scoring on CT angiogram in large vessel stroke[J]. J Clin Med, 2021, 10(6): 1296. DOI: 10.3390/jcm10061296.
Xu J, Peng MY, Zhou WZ, et al. The study on the correlation between hypoperfusion intensity ratio and angiography collateral circulation in acute ischemic stroke before endovascular thrombectomy therapy[J]. Chin J Magn Reson Imaging, 2020, 11(11): 971-974, 1055. DOI: 10.12015/issn.1674-8034.2020.11.003.
Guenego A, Fahed R, Albers GW, et al. Hypoperfusion intensity ratio correlates with angiographic collaterals in acute ischaemic stroke with M1 occlusion[J]. Eur J Neurol, 2020, 27(5): 864-870. DOI: 10.1111/ene.14181.
Lyndon D, van den Broek M, Niu B, et al. Hypoperfusion intensity ratio correlates with CTA collateral status in large-vessel occlusion acute ischemic stroke[J]. AJNR Am J Neuroradiol, 2021, 42(8): 1380-1386. DOI: 10.3174/ajnr.A7181.

PREV A preliminary study of synthetic magnetic resonance imaging in the clinical application of minimal hepatic encephalopathy
NEXT Susceptibility-weighted imaging joint deep learning to explore the potential association between superficial cerebral veins and deep white matter lesions

Tel & Fax: +8610-67113815    E-mail: