Collateral Status in Ischemic Stroke: A Comparison of Computed Tomography Angiography, Computed Tomography Perfusion, and Digital Subtraction Angiography.
Collateral Status in Ischemic Stroke: A Comparison of Computed Tomography Angiography, Computed Tomography Perfusion, and Digital Subtraction Angiography.
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DOI：
10.1097/rct.0000000000001090
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发表时间：
2020
影响因子：
1.3
通讯作者：
Wintermark M
中科院分区：
文献类型：
--
作者：
Kauw F;Dankbaar JW;Martin BW;Ding VY;Boothroyd DB;van Ommen F;de Jong HWAM;Kappelle LJ;Velthuis BK;Heit JJ;Wintermark M
文本中提供了补充的数字内容。目的：比较单期CT血管成像(CTA)和CT灌注三期CTA、多期CTA和颞叶最大密度投影(TMIP)图像与数字减影血管成像(DSA)对侧支循环的评价，并探讨侧支循环评价与临床预后的关系。连续接受CT灌注、CTA和DSA检查的急性缺血性卒中患者在血栓摘除前行颈内动脉闭塞，包括M1或M2节段。两名观察者用静态和动态(改良的美国介入和治疗神经放射学会)侧支分级方法评估所有CT图像，一名单独的观察者评估DSA(参考标准)。观察者间的一致性和一致性分别用科恩加权的κ和一致性相关系数来量化。影像评估与临床结果相关(改良朗金评分，≤2)。观察者间一致性(n=101)静态评估分别为0.46(TMIP)、0.58(3期CTA)、0.67(多期CTA)和0.69(单期CTA)，动态评估分别为0.52(3期CTA)和0.54(多期CTA)。静态评估的一致性相关系数(n=80)为0.08(3期CTA)、0.09(单期CTA)和0.23(多期CTA)，动态评估的一致性相关系数(n=80)分别为0.10(3期CTA)和0.27(多期CTA)。多期CTA(优势比[OR]1.7；95%可信区间[CI]，1.1-2.7)和tMIP图像(OR，2.0；95%CI，1.1-3.4)的静态侧支循环评分较高与改良Rankin评分2或以下相关，美国介入和治疗神经放射学会三期CTA(OR，1.5；95%CI，1.1-2.2)和多期CTA(OR，1.7；95%CI，1.1-2.6)的改良Rankin评分较高。CT和DSA评估结果的一致性较差。三期CTA和多期CTA的侧支状态评估与临床结果相关，而DSA评估的侧支状态与临床结果无关。
Supplemental digital content is available in the text. To compare assessment of collaterals by single-phase computed tomography (CT) angiography (CTA) and CT perfusion-derived 3-phase CTA, multiphase CTA and temporal maximum-intensity projection (tMIP) images to digital subtraction angiography (DSA), and relate collateral assessments to clinical outcome in patients with acute ischemic stroke. Consecutive acute ischemic stroke patients who underwent CT perfusion, CTA, and DSA before thrombectomy with occlusion of the internal carotid artery, the M1 or the M2 segments were included. Two observers assessed all CT images and one separate observer assessed DSA (reference standard) with static and dynamic (modified American Society of Interventional and Therapeutic Neuroradiology) collateral grading methods. Interobserver agreement and concordance were quantified with Cohen-weighted κ and concordance correlation coefficient, respectively. Imaging assessments were related to clinical outcome (modified Rankin Scale, ≤ 2). Interobserver agreement (n = 101) was 0.46 (tMIP), 0.58 (3-phase CTA), 0.67 (multiphase CTA), and 0.69 (single-phase CTA) for static assessments and 0.52 (3-phase CTA) and 0.54 (multiphase CTA) for dynamic assessments. Concordance correlation coefficient (n = 80) was 0.08 (3-phase CTA), 0.09 (single-phase CTA), and 0.23 (multiphase CTA) for static assessments and 0.10 (3-phase CTA) and 0.27 (multiphase CTA) for dynamic assessments. Higher static collateral scores on multiphase CTA (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1–2.7) and tMIP images (OR, 2.0; 95% CI, 1.1–3.4) were associated with modified Rankin Scale of 2 or less as were higher modified American Society of Interventional and Therapeutic Neuroradiology scores on 3-phase CTA (OR, 1.5; 95% CI, 1.1–2.2) and multiphase CTA (OR, 1.7; 95% CI, 1.1–2.6). Concordance between assessments on CT and DSA was poor. Collateral status evaluated on 3-phase CTA and multiphase CTA, but not on DSA, was associated with clinical outcome.