动态CT血管造影评估急性大脑中动脉卒中的侧支循环状态：采集时机及与最终梗死体积的关系
Assessment of Collateral Status by Dynamic CT Angiography in Acute MCA Stroke: Timing of Acquisition and Relationship with Final Infarct Volume.
作者信息
van den Wijngaard I R, Holswilder G, Wermer M J H, Boiten J, Algra A, Dippel D W J, Dankbaar J W, Velthuis B K, Boers A M M, Majoie C B L M, van Walderveen M A A
机构信息
From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.) Department of Neurology (I.R.v.d.W., J.B.), Medical Center Haaglanden, the Hague, the Netherlands
From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.).
出版信息
AJNR Am J Neuroradiol. 2016 Jul;37(7):1231-6. doi: 10.3174/ajnr.A4746. Epub 2016 Mar 31.
BACKGROUND AND PURPOSE
Dynamic CTA is a promising technique for visualization of collateral filling in patients with acute ischemic stroke. Our aim was to describe collateral filling with dynamic CTA and assess the relationship with infarct volume at follow-up.
MATERIALS AND METHODS
We selected patients with acute ischemic stroke due to proximal MCA occlusion. Patients underwent NCCT, single-phase CTA, and whole-brain CT perfusion/dynamic CTA within 9 hours after stroke onset. For each patient, a detailed assessment of the extent and velocity of arterial filling was obtained. Poor radiologic outcome was defined as an infarct volume of ≥70 mL. The association between collateral score and follow-up infarct volume was analyzed with Poisson regression.
RESULTS
Sixty-one patients with a mean age of 67 years were included. For all patients combined, the interval that contained the peak of arterial filling in both hemispheres was between 11 and 21 seconds after ICA contrast entry. Poor collateral status as assessed with dynamic CTA was more strongly associated with infarct volume of ≥70 mL (risk ratio, 1.9; 95% CI, 1.3-2.9) than with single-phase CTA (risk ratio, 1.4; 95% CI, 0.8-2.5). Four subgroups (good-versus-poor and fast-versus-slow collaterals) were analyzed separately; the results showed that compared with good and fast collaterals, a similar risk ratio was found for patients with good-but-slow collaterals (risk ratio, 1.3; 95% CI, 0.7-2.4).
CONCLUSIONS
Dynamic CTA provides a more detailed assessment of collaterals than single-phase CTA and has a stronger relationship with infarct volume at follow-up. The extent of collateral flow is more important in determining tissue fate than the velocity of collateral filling. The timing of dynamic CTA acquisition in relation to intravenous contrast administration is critical for the optimal assessment of the extent of collaterals.
背景与目的
动态CT血管造影（CTA）是一种用于观察急性缺血性脑卒中患者侧支循环灌注的有前景的技术。我们的目的是描述动态CTA下的侧支循环灌注情况，并评估其与随访时梗死体积的关系。
材料与方法
我们选取了因大脑中动脉近端闭塞导致急性缺血性脑卒中的患者。患者在卒中发作后9小时内接受了非增强CT（NCCT）、单相CTA以及全脑CT灌注/动态CTA检查。对于每位患者，均详细评估了动脉灌注的范围和速度。不良影像学结局定义为梗死体积≥70 mL。采用泊松回归分析侧支循环评分与随访时梗死体积之间的关联。
结果
纳入了61例平均年龄为67岁的患者。对于所有患者而言，双侧半球动脉灌注峰值所在的时间间隔为颈内动脉注入造影剂后的11至21秒。与单相CTA相比，动态CTA评估的侧支循环状态不良与梗死体积≥70 mL的关联更强（风险比，1.9；95%置信区间，1.3 - 2.9），而单相CTA的风险比为1.4（95%置信区间，0.8 - 2.5）。对四个亚组（良好与不良以及快速与缓慢侧支循环）进行了单独分析；结果显示，与良好且快速的侧支循环相比，良好但缓慢的侧支循环患者的风险比相似（风险比，1.3；95%置信区间，0.7 - 2.4）。
结论
与单相CTA相比，动态CTA能更详细地评估侧支循环，且与随访时的梗死体积有更强的关联。在决定组织转归方面，侧支循环血流的范围比侧支循环灌注速度更为重要。动态CTA采集时间与静脉注射造影剂的关系对于侧支循环范围的最佳评估至关重要。
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