1Department of Clinical Neurosciences,Calgary Stroke Program,Hotchkiss Brain Institute,University of Calgary,Canada.
2Department of Neurology,Dongsan Medical Center,Keimyung University,Daegu,South Korea.
Can J Neurol Sci. 2017 Sep;44(5):503-507. doi: 10.1017/cjn.2017.53.
We measured anterior cerebral artery (ACA)-middle cerebral artery (MCA) and posterior cerebral artery (PCA)-MCA pial filling on single-phase computed tomography angiograms (sCTAs) in acute ischemic stroke and correlate with the CTA-based Massachusetts General Hospital (MGH) and digital subtraction angiography (DSA)-based American Society of Interventional and Therapeutic Neuroradiology (ASITN) score.
Patients with acute stroke and M1 MCA±intracranial internal carotid artery occlusion on baseline CTA were included. Baseline sCTA was assessed for phase of image acquisition. An evaluator assessed collaterals using the Calgary Collateral (CC) Score (measures pial arterial filling in ACA-MCA and PCA-MCA regions separately), the CTA-based MGH score, and on DSA using the ASITN score. Infarct volumes were measured on 24- to 48-hour magnetic resonance imaging/ computed tomography.
Of 106 patients, baseline sCTA was acquired in early arterial phase in 9.9%, peak arterial in 50.7%, equilibrium in 32.4%, early venous in 5.6%, and late venous in 1.4%. Variance in ACA-MCA collaterals explained only 32% of variance in PCA-MCA collaterals on the CC score (Spearman's correlation coefficient rho [rho]=0.56). Correlation between ACA-MCA collaterals and the MGH score was strong (rho=0.8); correlation between PCA-MCA collaterals and this score was modest (rho=0.54). Correlation between ACA-MCA collaterals and the ASITN score was modest (n=53, rho=0.43); and correlation between PCA-MCA collaterals and ASITN score was poor (rho=0.33). Of the CTA-based scores, the CC Score (Akaike [AIC] 1022) was better at predicting follow-up infarct volumes than was the MGH score (AIC 1029).
Collateral assessments in acute ischemic stroke are best done using CTA with temporal resolution and by assessing regional variability. ACA-MCA and MCA-PCA collaterals should be evaluated separately.
我们在急性缺血性脑卒中患者的单相 CT 血管造影（sCTA）中测量大脑前动脉（ACA）-大脑中动脉（MCA）和大脑后动脉（PCA）-MCA 软脑膜充盈，并与 CTA 基础的麻省总医院（MGH）和数字减影血管造影（DSA）基础的介入治疗神经放射学会（ASITN）评分相关联。
纳入基线 CTA 上有急性脑卒中且 M1 MCA±颅内颈内动脉闭塞的患者。评估基线 sCTA 的图像采集相位。评估者使用卡尔加里侧支循环评分（CCA 评分）（分别评估 ACA-MCA 和 PCA-MCA 区域的软脑膜动脉充盈）、基于 CTA 的 MGH 评分和基于 DSA 的 ASITN 评分评估侧支循环。在 24-48 小时磁共振成像/计算机断层扫描上测量梗死体积。
在 106 例患者中，9.9%的基线 sCTA 为早期动脉期，50.7%的为峰值动脉期，32.4%的为平衡期，5.6%的为早期静脉期，1.4%的为晚期静脉期。CCA 评分中 ACA-MCA 侧支循环的方差仅解释了 PCA-MCA 侧支循环方差的 32%（斯皮尔曼相关系数 rho [rho]=0.56）。ACA-MCA 侧支循环与 MGH 评分之间的相关性很强（rho=0.8）；PCA-MCA 侧支循环与该评分的相关性适中（rho=0.54）。ACA-MCA 侧支循环与 ASITN 评分的相关性适中（n=53，rho=0.43）；PCA-MCA 侧支循环与 ASITN 评分的相关性较差（rho=0.33）。在基于 CTA 的评分中，CCA 评分（Akaike [AIC] 1022）比 MGH 评分（AIC 1029）更能预测随访时的梗死体积。
急性缺血性脑卒中的侧支循环评估最好使用具有时间分辨率的 CTA 进行，并通过评估区域变异性来进行。应分别评估 ACA-MCA 和 MCA-PCA 侧支循环。
