From the Departments of Biomedical Engineering and Physics (A.M.M.B., R.S.B., I.G.H.J., H.A.M.)
Radiology and Nuclear Medicine (A.M.M.B., I.G.H.J., O.A.B., L.F.M.B., C.B.L.M.M., H.A.M.).
AJNR Am J Neuroradiol. 2018 Jun;39(6):1074-1082. doi: 10.3174/ajnr.A5623. Epub 2018 Apr 19.
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.
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.
A total of 442 patients were included. The quantitative collateral score strongly correlated with the visual collateral score (ρ = 0.75) and was an independent predictor of mRS (adjusted odds ratio = 0.81; 95% CI, .77-.86) and follow-up infarct volume (exponent β = 0.88; < .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 ( = .048) and on functional independence ( = .049). Modification of the quantitative collateral score by acquisition phase on outcome was significant (mRS: = .004; follow-up infarct volume: < .001) in adjusted analysis.
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.
许多研究强调了侧支循环在急性缺血性脑卒中患者中的相关性。我们的目的是评估基线 CTA 上定量侧支评分与急性缺血性脑卒中患者结局的关系，并检验 CTA 采集时间是否会影响这种关系。
从荷兰急性缺血性卒中血管内治疗多中心随机临床试验（MR CLEAN）数据库中，回顾性收集了所有伴有颅内大血管闭塞的急性缺血性脑卒中患者的基线薄层 CTA 图像。定量侧支评分计算为双侧半球血管显影的比值，并与视觉侧支评分进行比较。主要结局是 90 天 mRS 评分和随访梗死体积。评估其与结局的关系和与治疗效果的相关性。确定 CTA 采集阶段对侧支评分与结局关系的影响。
共纳入 442 例患者。定量侧支评分与视觉侧支评分高度相关（ρ=0.75），且是 mRS（校正比值比=0.81；95%可信区间，0.77-0.86）和随访梗死体积（指数β=0.88；<0.001）的独立预测因子，每增加 10%。定量侧支评分预测功能独立（mRS 0-2）和随访梗死体积>90 mL 的曲线下面积分别为 0.71 和 0.69。在未校正的全序 mRS 量表（=0.048）和功能独立性（=0.049）分析中，我们发现定量侧支评分与血管内治疗效果之间存在显著的交互作用。在调整分析中，基于采集阶段的定量侧支评分对结局的修正具有显著意义（mRS：=0.004；随访梗死体积：<0.001）。
急性缺血性脑卒中患者的自动定量侧支评分是 CTA 基线侧支能力的可靠且与操作者无关的测量方法，有可能增加急性脑卒中患者血管内治疗的分诊。
