From the Jiangsu Key Laboratory of Molecular and Functional Imaging and Center of Interventional Radiology and Vascular Surgery, Departments of Radiology (Z.W., T.Y.T., C.H.Z., Y.Z., Z.Z., D.L.Z., G.D., S.H.J., G.J.T.), and Neurology (J.X., L.Y.G., Z.J.Z.), Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Rd, Nanjing 210009, China.
Radiology. 2020 Aug;296(2):393-400. doi: 10.1148/radiol.2020192029. Epub 2020 Jun 2.
Background Collateral status assessed with single- or multiphase CT angiography can be used to predict outcome in patients with acute ischemic stroke (AIS); however, little is known about whether these measures could be comparable with CT perfusion parameters. Purpose To compare the predictive ability of collateral score systems assessed with single- or multiphase CT angiography and CT perfusion parameters in determining clinical outcomes in patients with AIS. Materials and Methods In this retrospective study, data obtained from October 2017 to August 2018 in consecutive patients with AIS caused by isolated anterior circulation large artery occlusion and that were obtained within 24 hours after onset were reviewed. The collateral score was assessed by using established scoring systems described by Menon et al. The correlations between single- and multiphase collateral scores, hypoperfusion, and ischemic core volume and final infarct volume (FIV) determined by follow-up diffusion-weighted imaging or unenhanced CT were studied. Receiver operating characteristic curves and multivariable logistic regression analysis were performed to assess the predictive ability of scoring systems and CT perfusion parameters for a favorable clinical outcome. Results A total of 119 patients (median age, 75 years; interquartile range, 66-82 years; 74 men) were included. Both single- and multiphase Menon scores had a moderate negative correlation with FIV ( = -0.43, < .001; = -0.44, < .001). Receiver operating characteristic curve analysis revealed the multiphase Menon score performed better than the single-phase Menon score (area under the curve [AUC], 0.72 vs 0.64; = .045) in the prediction of a favorable 90-day modified Rankin scale score. There was no difference between multiphase Menon score and hypoperfusion volume (AUC, 0.72 vs 0.72; = .97) or ischemic core volume (AUC, 0.72 vs 0.71; = .94). Multivariable analysis showed multiphase Menon score was an independent predictor of good clinical outcomes (odds ratio = 3.04, = .001). Conclusion Multiphase Menon score performed better than single-phase Menon score and was comparable with CT perfusion parameters in determining clinical outcomes in patients with acute ischemic stroke. © RSNA, 2020.
背景 使用单期或多期 CT 血管造影评估侧支循环状态可用于预测急性缺血性脑卒中（AIS）患者的预后；然而，对于这些测量值是否可以与 CT 灌注参数相媲美知之甚少。目的 比较单期或多期 CT 血管造影评估的侧支评分系统和 CT 灌注参数在预测 AIS 患者临床结局方面的预测能力。材料与方法 本回顾性研究纳入了 2017 年 10 月至 2018 年 8 月连续收治的因孤立性前循环大动脉闭塞引起的 AIS 患者，发病后 24 小时内获得的数据。采用 Menon 等描述的既定评分系统评估侧支评分。研究了单期和多期侧支评分、低灌注和缺血核心体积与随访弥散加权成像或未增强 CT 确定的最终梗死体积（FIV）之间的相关性。进行了受试者工作特征曲线和多变量逻辑回归分析，以评估评分系统和 CT 灌注参数对良好临床结局的预测能力。结果 共纳入 119 例患者（中位年龄 75 岁；四分位距 66~82 岁；74 例男性）。单期和多期 Menon 评分均与 FIV 呈中度负相关（ = -0.43，<.001； = -0.44，<.001）。受试者工作特征曲线分析显示，多期 Menon 评分在预测 90 天改良 Rankin 量表评分良好方面优于单期 Menon 评分（曲线下面积[AUC]，0.72 比 0.64；=.045）。多期 Menon 评分与低灌注体积（AUC，0.72 比 0.72；=.97）或缺血核心体积（AUC，0.72 比 0.71；=.94）之间无差异。多变量分析显示，多期 Menon 评分是良好临床结局的独立预测因子（比值比=3.04，=.001）。结论 多期 Menon 评分在预测 AIS 患者的临床结局方面优于单期 Menon 评分，与 CT 灌注参数相当。
