Mueck Fabian, Hernandez Petzsche Moritz, Boeckh-Behrens Tobias, Maegerlein Christian, Linsenmaier Ulrich, Scaglione Mariano, Zimmer Claus, Ikenberg Benno, Berndt Maria
Institute for Diagnostic and Interventional Radiology, HELIOS Clinics Munich West, Munich Perlach & Augustinum Munich, 81241 Munich, Germany.
Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany.
Diagnostics (Basel). 2022 Jul 28;12(8):1817. doi: 10.3390/diagnostics12081817.
Purpose: Acute basilar artery occlusion, a neurovascular emergency leading to high rates of morbidity and mortality, is usually diagnosed by CT imaging. The outcome is partly dependent on etiology, with a worse outcome in occlusions with underlying basilar artery stenosis. As this occlusion type requires a more complex angiographic therapy, this study aimed to develop new CT markers in emergency admission imaging to rapidly identify underlying stenosis. Methods: A total of 213 consecutive patients (female n = 91, age in years (mean/SD/range): 72/13/28−97), who received endovascular treatment at a single comprehensive stroke center for acute basilar artery occlusion, were included in this study. After applying strict inclusion criteria for imaging analyses, novel CT imaging markers, such as ‘absolute density loss’ (ADL) and relative thrombus attenuation (CTA-index), that measure perviousness, were assessed for n = 109 patients by use of CT-angiography and correlated to different occlusion patterns (thrombotic vs. embolic). Inter-observer agreement was assessed using an intraclass correlation coefficient for independent measures of a radiologist and a neuroradiologist. Associations between the imaging markers and clinical and interventional parameters were tested. Results: CT markers differ between the subgroups of basilar artery occlusions with and without underlying stenosis (for ADL: 169 vs. 227 HU (p = 0.03), for CTA-index: 0.55 vs. 0.70 (p < 0.001)), indicating a higher perviousness in the case of stenosis. A good inter-rater agreement was observed for ADL and CTA-index measures (ICC 0.92/0.88). For the case of embolic occlusions, a more pervious thrombus correlates to shorter time intervals, longer procedure times, and worse reperfusion success (p-values < 0.05, respectively). Conclusions: ADL and CTA-index are easy to assess in the emergency setting of acute basilar artery occlusion with the use of routinely acquired CT-angiography. They show a high potential to differentiate thrombotic from embolic occlusions, with an impact on therapeutic decisions and angiographic procedures. Measurements can be quickly performed with good reliability, facilitating implementation in clinical practice.
急性基底动脉闭塞是一种导致高发病率和死亡率的神经血管急症，通常通过CT成像进行诊断。其预后部分取决于病因，潜在基底动脉狭窄的闭塞患者预后更差。由于这种闭塞类型需要更复杂的血管造影治疗，本研究旨在在急诊入院成像中开发新的CT标志物，以快速识别潜在的狭窄。方法：本研究纳入了在一家综合性卒中中心接受急性基底动脉闭塞血管内治疗的213例连续患者（女性91例，年龄（平均/标准差/范围）：72/13/28 - 97岁）。在对成像分析应用严格的纳入标准后，通过CT血管造影对109例患者评估了测量通透性的新CT成像标志物，如“绝对密度损失”（ADL）和相对血栓衰减（CTA指数），并将其与不同的闭塞模式（血栓形成性与栓塞性）相关联。使用组内相关系数评估放射科医生和神经放射科医生独立测量的观察者间一致性。测试成像标志物与临床和介入参数之间的关联。结果：有或无潜在狭窄的基底动脉闭塞亚组之间的CT标志物存在差异（ADL：169 vs. 227 HU（p = 0.03），CTA指数：0.55 vs. 0.70（p < 0.001）），表明狭窄情况下通透性更高。观察到ADL和CTA指数测量的观察者间一致性良好（ICC 0.92/0.88）。对于栓塞性闭塞的情况，血栓通透性越高，时间间隔越短，手术时间越长，再灌注成功率越低（p值分别<0.05）。结论：在急性基底动脉闭塞的急诊情况下，使用常规获取的CT血管造影可轻松评估ADL和CTA指数。它们在区分血栓形成性与栓塞性闭塞方面具有很高的潜力，对治疗决策和血管造影程序有影响。测量可以快速且可靠地进行，便于在临床实践中实施。
