Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany.
Department of Radiology, Helios Klinikum München West, Munich, Germany.
Clin Neuroradiol. 2021 Sep;31(3):773-781. doi: 10.1007/s00062-020-00957-4. Epub 2020 Sep 29.
Thrombus features on admission CT are useful imaging markers for clot characterization, stroke pathogenesis and outcome prediction. In this context, thrombus perviousness is a promising parameter, but reliable assessment in daily clinical practice is demanding. The aim of the present study was to evaluate an easy to assess measuring method for thrombus permeability at the time of admission.
The CTA-index, which measures relative thrombus attenuation on admission CTA, was compared to the known perviousness parameter in a cohort of 101 patients with large-vessel occlusions of the middle cerebral artery and correlated to clinical outcome parameters (mRS after 90 days, ≤2 rated as favorable). For validation, this correlation was tested in a second independent cohort (n = 87), and possible associations between the CTA-index and outcome measurements (NIHSS/mRS/mTICI) were assessed.
In the first cohort a coherence between conventional perviousness measurements and the CTA-index was shown. The CTA-index differed significantly between favorable (-0.55 ± 0.16) and non-favorable outcomes (-0.64 ± 0.14, p = 0.01). In the validation cohort this result could be independently reproduced (-0.52 ± 0.13/-0.70 ± 0.09, p < 0.01). The CTA-index showed an association with low NIHSS at discharge (p < 0.01), favorable outcome after 90 days (p < 0.001) and with better reperfusion (measured by mTICI score, p = 0.04).
The CTA-index is an easy to assess imaging parameter on admission CTA in the acute stroke phase and is associated with angiographic and clinical outcome. It can be considered as a simplified measuring method for thrombus perviousness, which is known to provide useful information for further stroke progress and clinical course as well as therapeutic and rehabilitative decisions.
入院 CT 上的血栓特征是血栓特征分析、卒中发病机制和预后预测的有用影像学标志物。在这种情况下，血栓通透性是一个很有前途的参数，但在日常临床实践中可靠的评估是具有挑战性的。本研究旨在评估一种易于评估的入院时血栓通透性测量方法。
本研究在 101 例大脑中动脉大血管闭塞患者的队列中比较了入院 CT 上的 CTA 指数与已知的通透性参数，并与临床预后参数（90 天后 mRS≤2 为有利）相关。为了验证，在第二个独立队列（n=87）中测试了这种相关性，并评估了 CTA 指数与预后测量（NIHSS/mRS/mTICI）之间的可能关联。
在第一个队列中，常规通透性测量与 CTA 指数之间显示出一致性。CTA 指数在有利（-0.55±0.16）和不利结局（-0.64±0.14，p=0.01）之间有显著差异。在验证队列中，这一结果可以独立重现（-0.52±0.13/-0.70±0.09，p<0.01）。CTA 指数与出院时 NIHSS 较低（p<0.01）、90 天后的有利结局（p<0.001）和更好的再灌注（通过 mTICI 评分测量，p=0.04）相关。
CTA 指数是急性卒中阶段入院 CT 上易于评估的影像学参数，与血管造影和临床预后相关。它可以被认为是一种简化的血栓通透性测量方法，已知该方法可提供有关进一步卒中进展和临床过程以及治疗和康复决策的有用信息。
