Cao Ruoyao, Jiang Yun, Li Ling, Yang Ximeng, Wang Hong, Chen Min, Chen Juan
Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Graduate School of Peking Union Medical College, Beijing, China.
Quant Imaging Med Surg. 2022 Nov;12(11):5030-5043. doi: 10.21037/qims-22-245.
To establish a novel cortical venous collateral score based on four-dimensional computed tomography angiography (4D CTA) and to assess the relationship between the score and clinical outcomes in patients with acute ischemic stroke (AIS) after endovascular treatments (EVTs).
This was a retrospective case-control study designed to evaluate all consecutive patients with large vessel occlusion in unilateral anterior circulation who underwent EVTs at a single institution. Two independent neuroradiologists evaluated venous collaterals using different venous collateral scores: a cortical venous collateral score based on 4D CTA (4D-VCS), the prognostic evaluation based on cortical vein score difference in stroke (PRECISE) score, and the cortical vein opacification score (COVES). Spearman correlation analysis was used to analyze the correlation of different venous collateral scoring systems with final infarct volume (FIV), modified Rankin Scale (mRS) score, and artery collateral score. Multivariate logistic regression analysis was used to identify the prognostic value of each model. The areas under the curve (AUC) of the receiver operating characteristic (ROC) curve of the 6 models were compared by the DeLong test.
A total of 107 patients were enrolled in the study. The AUC of 4D-VCS was 0.92 [95% confidence interval (CI): 0.85 to 0.96; P<0.0001]. The 4D-VCS was highly correlated with FIV (r=-0.615; 95% CI: -0.737 to -0.473; P<0.001), mRS score (r=-0.706; 95% CI: -0.789 to -0.602; P<0.001), and arterial collateral score (r=0.769; 95% CI: 0.678 to 0.838; P<0.001). There were statistically significant differences between model 1 (AUC, 0.89; 95% CI: 0.81 to 0.94) and model 2 (AUC, 0.94; 95% CI: 0.88 to 0.98) (P=0.025), model 1 (AUC, 0.89; 95% CI: 0.81 to 0.94) and model 3 (AUC, 0.93; 95% CI: 0.87 to 0.97) (P=0.045), model 1 (AUC, 0.89; 95% CI: 0.81 to 0.94) and model 6 (AUC, 0.95; 95% CI: 0.89 to 0.98) (P=0.011), and model 2 (AUC, 0.94; 95% CI: 0.88 to 0.98) and model 5 (AUC, 0.89; 95% CI: 0.82 to 0.94) (P=0.032).
The findings of this study suggested that 4D-VCS, a novel measurement of venous enhancement based on 4D CTA, may be accurately used to identify AIS patients with high risk of poor clinical outcome after EVTs.
基于四维计算机断层血管造影（4D CTA）建立一种新的皮质静脉侧支循环评分，并评估该评分与急性缺血性卒中（AIS）患者血管内治疗（EVT）后临床结局之间的关系。
这是一项回顾性病例对照研究，旨在评估在单一机构接受EVT的所有连续性单侧前循环大血管闭塞患者。两名独立的神经放射科医生使用不同的静脉侧支循环评分评估静脉侧支循环：基于4D CTA的皮质静脉侧支循环评分（4D-VCS）、基于卒中皮质静脉评分差异的预后评估（PRECISE）评分和皮质静脉显影评分（COVES）。采用Spearman相关性分析来分析不同静脉侧支循环评分系统与最终梗死体积（FIV）、改良Rankin量表（mRS）评分和动脉侧支循环评分之间的相关性。采用多因素逻辑回归分析来确定每个模型的预后价值。通过DeLong检验比较6个模型的受试者操作特征（ROC）曲线下面积（AUC）。
本研究共纳入107例患者。4D-VCS的AUC为0.92[95%置信区间（CI）：0.85至0.96；P<0.0001]。4D-VCS与FIV（r=-0.615；95%CI：-0.737至-0.473；P<0.001）、mRS评分（r=-0.706；95%CI：-0.789至-0.602；P<0.001）和动脉侧支循环评分（r=0.769；95%CI：0.678至0.838；P<0.001）高度相关。模型1（AUC，0.89；95%CI：0.81至0.94）与模型2（AUC，0.94；95%CI：0.88至0.98）之间存在统计学显著差异（P=0.025），模型1（AUC，0.89；95%CI：0.81至0.94）与模型3（AUC，0.93；95%CI：0.87至0.97）之间存在统计学显著差异（P=0.045），模型1（AUC，0.89；95%CI：0.81至0.94）与模型6（AUC，0.95；95%CI：0.89至0.98）之间存在统计学显著差异（P=0.011），模型2（AUC，0.94；95%CI：0.88至0.98）与模型5（AUC，0.89；95%CI：0.82至0.94）之间存在统计学显著差异（P=0.032）。
本研究结果表明，4D-VCS是一种基于4D CTA的静脉强化新测量方法，可准确用于识别EVT后临床结局不良风险高的AIS患者。
