Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, PR China.
State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, PR China.
Acta Radiol. 2021 Jan;62(1):73-79. doi: 10.1177/0284185120911893. Epub 2020 Mar 30.
The methods used for grading leptomeningeal collateral flow (LMF) on single-phase computed tomography angiography (CTA) are heterogeneous and limited by temporal resolution.
To compare the reliability of relative filling time delay (rFTD) on CT perfusion source images (CTP-SI) and the currently used single-phase CTA collateral assessment methods and evaluate their ability to predict clinical outcomes in acute ischemic stroke patients.
We analyzed consecutive middle cerebral artery or internal carotid artery occlusion patients who received multimodal CT before treatment and within 12 h of stroke symptom onset from October 2015 to December 2018. Patients were dichotomized using the 90-day mRS into good (0-1) versus adverse (2-6) outcomes. CTP-SI was used to identify the rFTD score. CTA images were reconstructed to assess collateral status using the collateral score (Cs) and region leptomeningeal collateral score (rLMCs). Two observers independently assessed images.
The baseline characteristics (n = 54) were median age of 67 years and 68.5% of the participants were men. The baseline median NIHSS was 14. Good clinical outcomes were observed in 19 (35.2%) patients. The value was higher for rFTDs ( = 0.779, < 0.001) than Cs ( = 0.666, < 0.001) and rLMCs ( = 0.763, < 0.001). Higher rFTDs were correlated with lower rLMCs (Spearman's rho -0.68, < 0.001) and Cs (rho -0.66, < 0.001). In multivariate logistic regression, rFTD was associated with functional outcomes ( = 0.044).
The rFTDs method is comparable to single-phase CTA-based assessments in assessing LMFs in acute ischemic stroke patients. Higher rFTDs is independently associated with adverse long-term functional outcomes.
单相位计算机断层血管造影术（CTA）用于分级软脑膜侧支循环（LMF）的方法具有异质性且受到时间分辨率的限制。
比较 CT 灌注源图像（CTP-SI）上的相对充盈时间延迟（rFTD）与目前使用的单相 CTA 侧支评估方法的可靠性，并评估它们在急性缺血性脑卒中患者中预测临床结局的能力。
我们分析了 2015 年 10 月至 2018 年 12 月期间，在发病 12 小时内接受多模态 CT 治疗的连续大脑中动脉或颈内动脉闭塞患者。根据 90 天 mRS 将患者分为良好（0-1）与不良（2-6）结局。使用 rFTD 评分来识别 CTP-SI。重建 CTA 图像以使用侧支评分（Cs）和区域软脑膜侧支评分（rLMCs）评估侧支状态。两名观察者独立评估图像。
基线特征（n=54）为中位年龄 67 岁，68.5%的患者为男性。基线 NIHSS 中位数为 14。19 例（35.2%）患者获得良好的临床结局。rFTDs 的 值（ = 0.779， < 0.001）高于 Cs（ = 0.666， < 0.001）和 rLMCs（ = 0.763， < 0.001）。较高的 rFTDs 与较低的 rLMCs（Spearman's rho -0.68， < 0.001）和 Cs（rho -0.66， < 0.001）相关。多变量逻辑回归显示，rFTD 与功能结局相关（ = 0.044）。
rFTDs 方法与单相 CTA 评估方法在评估急性缺血性脑卒中患者的 LMF 方面具有可比性。较高的 rFTDs 与不良的长期功能结局独立相关。
