静脉闭塞影像评分：一种用于脑静脉窦血栓形成的新型定量评分工具。

The Venous Occlusion Image Score: A Novel Quantitative Scoring Instrument for Cerebral Venous Sinus Thrombosis.

机构信息

Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, No. 1, Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, P R China.

Department of Neurosurgery, University-Town Hospital of Chongqing Medical University, Chongqing, P R China.

出版信息

J Stroke Cerebrovasc Dis. 2021 Jul;30(7):105845. doi: 10.1016/j.jstrokecerebrovasdis.2021.105845. Epub 2021 May 5.

DOI:10.1016/j.jstrokecerebrovasdis.2021.105845

PMID:33964546

Abstract

PURPOSE

This study aims to test the validity of a new quantitative scoring instrument-the Venous Occlusion Image Score (VOIS), and assess the diagnostic and prognostic value of VOIS for cerebral venous sinus thrombosis (CVST).

METHODS

The VOIS divided the major cerebral venous sinuses and internal jugular veins into nine parts of interest. CT venography and DSA source images and reconstruction were extracted from the database, then interpreted and scored independently according to VOIS by a panel of three reviewers. Inter-observer and intra-observer reliability were determined using the intraclass correlation coefficient (ICC) and the kappa coefficient (κ). The primary outcome was the 3-month functional outcome and evaluated by modified Rankin Scale (mRS). The sensitivity and specificity of VOIS for the primary outcomes were computed. Logistic regression was applied to evaluate the association between the score on VOIS and the primary outcomes.

RESULTS

Fifty-six patients with CVST were included in the study. For 16 patients underwent cerebral CTV and DSA, excellent interobserver agreement was observed for DSA (ICC=0.90, 95%CI = 0.87 - 0.92, P < 0.001), and CTV (ICC = 0.92, 95%CI = 0.84 - 0.93, P < 0.001). The κ coefficient of agreement for the two radiology measures was 0.88 (95%CI = 0.79-0.92), indicating good inter-method agreement. For 56 patients followed up by CTV, baseline VOIS value correlated inversely with the severity of stroke on the National Institutes of Health Stroke Scale (r = -0·53, P < 0·001), and modified Rankin Scale (r = -0·59, P < 0·001). Baseline CTV-VOIS value predicted functional outcome (P < 0·05).

CONCLUSION

VOIS may serve as a convenient and reliable method in the treatment guidance and outcome prediction of patients with CVST.

摘要

目的

本研究旨在验证一种新的定量评分工具——静脉闭塞图像评分（Venous Occlusion Image Score，VOIS）的有效性，并评估 VOIS 对脑静脉窦血栓形成（Cerebral Venous Sinus Thrombosis，CVST）的诊断和预后价值。

方法

VOIS 将主要脑静脉窦和颈内静脉分为 9 个感兴趣区。从数据库中提取 CT 静脉造影和 DSA 源图像和重建图像，然后由三位评审员根据 VOIS 进行独立解读和评分。采用组内相关系数（Intraclass Correlation Coefficient，ICC）和 Kappa 系数（κ）评估观察者间和观察者内的可靠性。主要结局是 3 个月的功能结局，采用改良 Rankin 量表（mRS）进行评估。计算 VOIS 对主要结局的敏感性和特异性。采用逻辑回归评估 VOIS 评分与主要结局之间的关联。

结果

本研究纳入了 56 例 CVST 患者。对于 16 例接受脑 CTV 和 DSA 检查的患者，DSA（ICC=0.90，95%置信区间为 0.87-0.92，P<0.001）和 CTV（ICC=0.92，95%置信区间为 0.84-0.93，P<0.001）的观察者间一致性极好。两种影像学检查方法的κ系数一致性为 0.88（95%置信区间为 0.79-0.92），表明一致性良好。对于 56 例接受 CTV 随访的患者，基线 VOIS 值与国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）（r=-0.53，P<0.001）和改良 Rankin 量表（modified Rankin Scale，mRS）（r=-0.59，P<0.001）上的卒中严重程度呈负相关。基线 CTV-VOIS 值可预测功能结局（P<0.05）。