From the Department of Radiology (T.D.F., R.K., G.K., M.P.M., M.W., J.J.H.) and Department of Neurology and Neurological Sciences (S.C., M.M., M.G.L., G.W.A.), Stanford University School of Medicine, 300 Pasteur Dr, Room S047, Stanford, CA 94305; and Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (L.M., G.B., F.F., J.F.).
Radiology. 2021 Jun;299(3):682-690. doi: 10.1148/radiol.2021203651. Epub 2021 Apr 6.
Background Ischemic lesion net water uptake (NWU) at noncontrast head CT enables quantification of cerebral edema in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Purpose To assess whether favorable venous outflow (VO) profiles at CT angiography are associated with reduced NWU and good functional outcomes in patients with AIS due to LVO. Materials and Methods This multicenter retrospective cohort study evaluated consecutive patients with AIS due to LVO who underwent thrombectomy triage between January 2013 and December 2019. Arterial collateral vessel status (Tan scale) and venous output were measured at CT angiography. Venous outflow was graded with use of the cortical vein opacification score, which quantifies opacification of the vein of Labbé, sphenoparietal sinus, and superficial middle cerebral vein. Favorable VO was regarded as a score of 3-6 and unfavorable VO as a score of 0-2. NWU was determined at follow-up noncontrast CT. Multivariable regression analyses were performed to determine the association between favorable VO profiles and NWU after treatment and good functional outcome (modified Rankin Scale, ≤2). Results A total of 580 patients were included. Of the 580 patients, 231 had favorable VO (104 women; median age, 73 years [interquartile range {IQR}, 62-81 years]) and 349 had unfavorable VO (190 women; median age, 77 years [IQR, 66-84 years]). Compared with patients with unfavorable VO, those with favorable VO exhibited lower baseline National Institutes of Health Stroke Scale score (median, 12.5 [IQR, 7-17] vs 17 [IQR, 13-21]), higher Alberta Stroke Program Early CT Score (median, 9 [IQR, 7-10] vs 7 [IQR, 6-8]), and less NWU after treatment (median, 7% [IQR, 4.6%-11.5%] vs 17.9% [IQR, 12.3%-22.2%]). In a multivariable regression analysis, NWU mean difference between patients with unfavorable VO and those with favorable VO was 6.1% (95% CI: 4.9, 7.3; < .001) regardless of arterial CT angiography collateral vessel status (b coefficient, 0.72 [95% CI: -0.59, 2.03; = .28]). Favorable VO (odds ratio [OR]: 4.1 [95% CI: 2.2, 7.7]; < .001) and reduced NWU after treatment (OR: 0.77 [95% CI: 0.73, 0.83]; < .001) were independently associated with good functional outcomes. Conclusion Favorable venous outflow (VO) correlated with reduced ischemic net water uptake (NWU) after treatment. Reduced NWU and favorable VO were associated with good functional outcomes regardless of CT angiography arterial collateral vessel status. © RSNA, 2021
背景 头部 CT 平扫时的缺血性损伤净水分摄取（NWU）可定量评估因大血管闭塞（LVO）导致的急性缺血性脑卒中（AIS）患者的脑水肿。目的 评估 CT 血管造影（CTA）中是否存在良好的静脉流出（VO）特征与 LVO 所致 AIS 患者的低 NWU 和良好的功能结局是否相关。
材料与方法 本多中心回顾性队列研究纳入了 2013 年 1 月至 2019 年 12 月期间因 LVO 而行取栓分流的连续 AIS 患者。在 CTA 上测量动脉侧支血管状态（Tan 分级）和静脉输出。使用皮质静脉显影评分评估静脉流出，该评分量化了 Labbe 静脉、蝶顶窦和大脑浅中静脉的显影程度。VO 良好定义为 3-6 分，VO 不良定义为 0-2 分。在随访时进行非增强 CT 以确定 NWU。采用多变量回归分析确定治疗后 VO 特征与 NWU 之间的关联以及与良好功能结局（改良 Rankin 量表，≤2 分）的关系。
结果 共纳入 580 例患者。580 例患者中，231 例 VO 良好（104 例女性；中位年龄为 73 岁[四分位距 {IQR} ：62-81 岁]），349 例 VO 不良（190 例女性；中位年龄为 77 岁[IQR：66-84 岁]）。与 VO 不良的患者相比，VO 良好的患者基线 NIHSS 评分更低（中位数：12.5[IQR：7-17] vs 17[IQR：13-21]）， Alberta Stroke Program Early CT 评分更高（中位数：9[IQR：7-10] vs 7[IQR：6-8]），治疗后 NWU 更低（中位数：7%[IQR：4.6%-11.5%] vs 17.9%[IQR：12.3%-22.2%]）。在多变量回归分析中，无论 CTA 动脉侧支血管状态如何，VO 不良与 VO 良好的患者之间的 NWU 平均差值为 6.1%（95% CI：4.9，7.3； <.001）（b 系数，0.72[95% CI：-0.59，2.03； =.28]）。VO 良好（比值比 [OR]：4.1[95% CI：2.2，7.7]； <.001）和治疗后 NWU 降低（OR：0.77[95% CI：0.73，0.83]； <.001）与良好的功能结局独立相关。
结论 良好的静脉流出（VO）与治疗后缺血性净水分摄取（NWU）减少相关。无论 CTA 动脉侧支血管状态如何，NWU 减少和 VO 良好均与良好的功能结局相关。
