Department of Radiology, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China.
Department of Radiology, Zhongshan Hospital Affiliated to Xiamen University, School of Medicine, Xiamen University, Xiamen 361004, China.
Br J Radiol. 2024 Jun 18;97(1159):1335-1342. doi: 10.1093/bjr/tqae104.
To investigate whether cerebral collateral and venous outflow (VO) patterns on colour-coded multi-phase computed tomography angiography (mCTA) can estimate ischaemic core growth rate (IGR) and predict 90-day functional independence for patients with late-presenting acute ischaemic stroke (AIS).
The retrospective analysis included 127 AIS patients with a late time window. All patients underwent baseline mCTA with colour-coded reconstruction and computed tomography perfusion. Both collateral score and VO score on colour-coded mCTA maps were analysed and recorded. The IGR was calculated as ischaemic core volume divided by the time from onset to imaging. A 90-day modified Rankin Scale score of 0-2 was defined as functional independence. Kendall's Tau-b analysis was used for nonparametric correlation analysis. Propensity scores, logistic regressions, and receiver operator characteristic (ROC) curves were applied to construct the prediction model.
Moderate correlations were found between collateral delay and IGR (Tau-b = -0.554) and between VO and IGR (Tau-b = -0.501). High collateral score (odds ratio = 3.01) and adequate VO (odds ratio = 4.89) remained independent predictors for 90-day functional independence after adjustment. The joint predictive model, which integrated the VO score and clinical features, demonstrated an area under the ROC curve (AUC) of 0.878. The AUCs of collateral score and VO score were 0.836 and 0.883 for outcome prediction after adjustment.
Cerebral collateral and VO patterns based on colour-coded mCTA can effectively predict infarct progression and 90-day clinical outcomes, even for AIS patients beyond the routine time window.
Colour-coded mCTA is a readily understandable post-processing technique for the rapid assessment of collateral circulation and VO status in stroke imaging. A moderate correlation was observed between the characteristics of collateral delay/VO on colour-coded mCTA and IGR in patients with AIS. Both high-quality collateral circulation and "red superficial middle cerebral vein sign" can predict 90-day functional independence even for patients beyond the routine time window.
探讨彩色多相 CT 血管造影（mCTA）上的脑侧支循环和静脉回流（VO）模式是否可以预测迟发性急性缺血性卒中（AIS）患者的缺血核心增长率（IGR）和 90 天的功能独立性。
本回顾性分析纳入了 127 例具有晚期时间窗的 AIS 患者。所有患者均行基线 mCTA 检查，采用彩色编码重建和 CT 灌注。分析并记录侧支循环评分和彩色 mCTA 图上的 VO 评分。IGR 计算为缺血核心体积除以从发病到成像的时间。90 天改良 Rankin 量表评分为 0-2 定义为功能独立性。采用 Kendall's Tau-b 分析进行非参数相关分析。应用倾向评分、逻辑回归和受试者工作特征（ROC）曲线构建预测模型。
发现侧支循环延迟与 IGR 之间存在中度相关性（Tau-b=-0.554），VO 与 IGR 之间也存在中度相关性（Tau-b=-0.501）。校正后，高侧支循环评分（优势比=3.01）和适当的 VO（优势比=4.89）仍然是 90 天功能独立性的独立预测因素。整合 VO 评分和临床特征的联合预测模型的 ROC 曲线下面积（AUC）为 0.878。校正后，侧支循环评分和 VO 评分对结局预测的 AUC 分别为 0.836 和 0.883。
基于彩色 mCTA 的脑侧支循环和 VO 模式可有效预测梗死进展和 90 天临床结局，即使对于超过常规时间窗的 AIS 患者也是如此。
彩色 mCTA 是一种易于理解的后处理技术，可快速评估卒中成像中的侧支循环和 VO 状态。在 AIS 患者中，观察到彩色编码 mCTA 上侧支循环延迟/VO 特征与 IGR 之间存在中度相关性。高质量的侧支循环和“红色浅大脑中静脉征”都可以预测 90 天的功能独立性，即使对于超过常规时间窗的患者也是如此。
