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Thrombus length discrepancy on dual-phase CT can predict clinical outcome in acute ischemic stroke

 Mina Park  ;  Kyung-eun Kim  ;  Na-Young Shin  ;  Seung-Koo Lee  ;  Soo Mee Lim  ;  Dongbeom Song  ;  Ji Hoe Heo  ;  Jin Woo Kim  ;  Se Won Oh 
 EUROPEAN RADIOLOGY, Vol.26(7) : 2215-2222, 2016 
Journal Title
Issue Date
Aged ; Aged, 80 and over ; Brain Ischemia/diagnostic imaging ; Cerebral Angiography/methods ; Computed Tomography Angiography ; Contrast Media ; Female ; Humans ; Image Processing, Computer-Assisted ; Intracranial Thrombosis/diagnostic imaging* ; Male ; Odds Ratio ; Prognosis ; Stroke/diagnostic imaging* ; Tomography, X-Ray Computed/methods*
Brain Infarction ; Middle cerebral artery ; Neuroimaging ; Stroke ; Tomography, X-Ray computed
OBJECTIVES: The thrombus length may be overestimated on early arterial computed tomography angiography (CTA) depending on the collateral status. We evaluated the value of a grading system based on the thrombus length discrepancy on dual-phase CT in outcome prediction. METHODS: Forty-eight acute ischemic stroke patients with M1 occlusion were included. Dual-phase CT protocol encompassed non-contrast enhanced CT, CTA with a bolus tracking technique, and delayed contrast enhanced CT (CECT) performed 40s after contrast injection. The thrombus length discrepancy between CTA and CECT was graded by using a three-point scale: G0 = no difference; G1 = no difference in thrombus length, but in attenuation distal to thrombus; G2 = difference in thrombus length. Univariate and multivariate analyses were performed to define independent predictors of poor clinical outcome at 3 months. RESULTS: The thrombus discrepancy grade showed significant linear relationships with both the collateral status (P?=?0.008) and the presence of antegrade flow on DSA (P?=?0.010) with good interobserver agreement (κ?=?0.868). In a multivariate model, the presence of thrombus length discrepancy (G2) was an independent predictor of poor clinical outcome [odds ratio?=?11.474 (1.350-97.547); P =0.025]. CONCLUSIONS: The presence of thrombus length discrepancy on dual-phase CT may be a useful predictor of unfavourable clinical outcome in acute M1 occlusion patients.EY POINTS: ? Early arterial phase CTA may underestimate thrombus length. ? Thrombus length discrepancy grade reflects collateral status or presence of antegrade flow. ? Outcome prediction may be better with thrombus length grade than collateral score.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyung Eun(김경은)
Park, Mina(박미나) ORCID logo https://orcid.org/0000-0002-2005-7560
Song, Dong Beom(송동범)
Lee, Seung Koo(이승구) ORCID logo https://orcid.org/0000-0001-5646-4072
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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