From the Departments of Radiology (I.G.H.J., O.A.B., K.M.T., H.A.M., C.B.L.M.M., R.v.d.B.), Neurology (Y.B.W.E.M.R.), and Biomedical Engineering and Physics (H.A.M.), Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, the Netherlands; Department of Biomedical Sciences, Free University of Amsterdam, Amsterdam, the Netherlands (A.B.v.V.); Departments of Radiology (I.G.H.J., W.H.v.Z.) and Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM) (R.J.v.O.), Maastricht University Medical Center, Maastricht, the Netherlands; Departments of Neurology (O.A.B., D.W.J.D.), Public Health (H.F.L.), and Radiology (A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Robotics and Mechatronics, University of Twente, Enschede, the Netherlands (C.H.S.); Departments of Radiology (M.A.A.v.W.), and Neurology (I.R.v.d.W.), Leiden University Medical Center, Leiden, the Netherlands; and Department of Neurology, Medisch Centrum Haaglanden, Den Haag, the Netherlands (I.R.v.d.W.).
Radiology. 2018 Feb;286(2):643-650. doi: 10.1148/radiol.2017162445. Epub 2017 Aug 11.
Purpose To assess the degree of cortical vein opacification in patients with internal carotid artery or middle cerebral artery (MCA) stroke and to evaluate the relationship with treatment benefit from intra-arterial therapy (IAT). Materials and Methods Written informed consent was obtained from all patients in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands. From the trial's database, all patients (recruited from December 2010 until March 2014) with baseline computed tomographic (CT) angiograms were retrospectively included. Enhancement of the vein of Labbé, sphenoparietal sinus, and superficial middle cerebral vein was graded by one neuroradiologist, as follows: 0, not visible; 1, moderate opacification; and 2, full opacification. The sum for the ipsilateral hemisphere was calculated, resulting in the cortical vein opacification score (COVES) (range, 0-6). Primary outcome was the modified Rankin Scale score at 90 days. Association with treatment according to full cortical vein score and different dichotomized cutoff points was estimated with ordinal logistic regression. Interobserver agreement was assessed by two separate observers who reviewed 100 studies each. Results In total, 397 patients were analyzed. Interaction of the cortical vein score with treatment was significant (P = .044) when dichotomized COVES was 0 versus more than 0. The adjusted odds ratio for shift toward better functional outcome was 1.0 (95% confidence interval [CI]: 0.5, 2.0) for a COVES of 0 (n = 123) and 2.2 (95% CI: 1.6, 4.1) for a COVES greater than 0 (n = 274). The multirater κ value was 0.73. Conclusion In this study, patients with acute middle cerebral artery stroke with absence of cortical vein opacification in the affected hemisphere (COVES = 0) appeared to have no benefit from IAT, whereas patients with venous opacification (COVES >0) were shown to benefit from IAT. RSNA, 2017 Clinical trial registration nos. NTR(1804) and ISRCTN10888758 Online supplemental material is available for this article.
评估颈内动脉或大脑中动脉（MCA）卒中患者的皮质静脉显影程度，并评估其与动脉内治疗（IAT）获益的关系。
所有患者均签署了荷兰多中心急性缺血性卒中血管内治疗随机临床试验的书面知情同意书。从试验数据库中，回顾性纳入所有基线 CT 血管造影的患者（2010 年 12 月至 2014 年 3 月招募）。一位神经放射科医生对 Labbe 静脉、蝶顶窦和大脑浅中静脉的增强情况进行分级：0 级，不可见；1 级，中度显影；2 级，完全显影。计算对侧半球的总和，得到皮质静脉显影评分（COVES）（范围：0-6）。主要结局为 90 天时改良 Rankin 量表评分。根据全皮质静脉评分和不同的二分截断点与治疗的关联，采用有序逻辑回归进行估计。两名观察者分别对 100 项研究进行了评估，以评估观察者间的一致性。
共分析了 397 例患者。当 COVES 为 0 与大于 0 时，皮质静脉评分与治疗的交互作用具有统计学意义（P =.044）。COVES 为 0（n = 123）时，功能结局改善的调整比值比为 1.0（95%置信区间[CI]：0.5，2.0），COVES 大于 0（n = 274）时为 2.2（95% CI：1.6，4.1）。多评估者 κ 值为 0.73。
在这项研究中，大脑中动脉卒中的患者，如果患侧半球无皮质静脉显影（COVES = 0），似乎不能从 IAT 中获益，而静脉显影（COVES >0）的患者则能从 IAT 中获益。RSNA，2017
NTR(1804)和 ISRCTN10888758
在线补充材料可在本文中获取。
