Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke

被引：51

作者：

Boers, A. M. M. ^{[1
,2
,4
]}

Sales Barros, R. ^{[1
]}

Jansen, I. G. H. ^{[1
,2
]}

Berkhemer, O. A. ^{[2
]}

Beenen, L. F. M. ^{[2
]}

Menon, B. K. ^{[6
]}

Dippel, D. W. J. ^{[7
]}

van der Lugt, A. ^{[8
]}

van Zwam, W. H. ^{[9
]}

Roos, Y. B. W. E. M. ^{[3
]}

van Oostenbrugge, R. J. ^{[10
,11
]}

Slump, C. H. ^{[4
,5
]}

Majoie, C. B. L. M. ^{[2
]}

Marquering, H. A. ^{[1
,2
]}

机构：

[1] Acad Med Ctr, Dept Biomed Engn & Phys, Meibergdreef 9, NL-1100 DD Amsterdam, Netherlands

[2] Acad Med Ctr, Dept Radiol & Nucl Med, Amsterdam, Netherlands

[3] Acad Med Ctr, Dept Neurol, Amsterdam, Netherlands

[4] Univ Twente, Dept Robot & Mechatron, Enschede, Netherlands

[5] Univ Twente, MIRA Inst Biomed Engn & Tech Med, Enschede, Netherlands

[6] Univ Calgary, Hotchkiss Brain Inst, Cumming Sch Med, Foothills Hosp,Dept Clin Neurosci, Calgary, AB, Canada

[7] Erasmus MC, Dept Neurol, Rotterdam, Netherlands

[8] Erasmus MC, Dept Radiol, Rotterdam, Netherlands

[9] Maastricht UMC, Dept Radiol, Maastricht, Netherlands

[10] Maastricht UMC, Dept Neurol, Maastricht, Netherlands

[11] Cardiovasc Res Inst Maastricht, Maastricht, Netherlands

来源：

AMERICAN JOURNAL OF NEURORADIOLOGY | 2018年 / 39卷 / 06期

关键词：

ANTERIOR CIRCULATION STROKE; INTRAARTERIAL TREATMENT; INFARCT VOLUME; ENDOVASCULAR TREATMENT; IMAGING SELECTION; FLOW ASSESSMENT; OUTCOMES; THROMBECTOMY; TRIALS; REPERFUSION;

D O I：

10.3174/ajnr.A5623

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND AND PURPOSE: Many studies have emphasized the relevance of collateral flow in patients presenting with acute ischemic stroke. Our aim was to evaluate the relationship of the quantitative collateral score on baseline CTA with the outcome of patients with acute ischemic stroke and test whether the timing of the CTA acquisition influences this relationship. MATERIALS AND METHODS: From the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) data base, all baseline thin-slice CTA images of patients with acute ischemic stroke with intracranial large-vessel occlusion were retrospectively collected. The quantitative collateral score was calculated as the ratio of the vascular appearance of both hemispheres and was compared with the visual collateral score. Primary outcomes were 90-day mRS score and follow-up infarct volume. The relation with outcome and the association with treatment effect were estimated. The influence of the CTA acquisition phase on the relation of collateral scores with outcome was determined. RESULTS: A total of 442 patients were included. The quantitative collateral score strongly correlated with the visual collateral score ( = 0.75) and was an independent predictor of mRS (adjusted odds ratio = 0.81; 95% CI, .77-.86) and follow-up infarct volume (exponent = 0.88; P < .001) per 10% increase. The quantitative collateral score showed areas under the curve of 0.71 and 0.69 for predicting functional independence (mRS 0-2) and follow-up infarct volume of >90 mL, respectively. We found significant interaction of the quantitative collateral score with the endovascular therapy effect in unadjusted analysis on the full ordinal mRS scale (P = .048) and on functional independence (P = .049). Modification of the quantitative collateral score by acquisition phase on outcome was significant (mRS: P = .004; follow-up infarct volume: P < .001) in adjusted analysis. CONCLUSIONS: Automated quantitative collateral scoring in patients with acute ischemic stroke is a reliable and user-independent measure of the collateral capacity on baseline CTA and has the potential to augment the triage of patients with acute stroke for endovascular therapy.

引用

页码：1074 / 1082

页数：9

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