301. Collateral flow and brain changes on computed tomography angiography predict infarct volume on early diffusion-weighted imaging.
- Author
-
Aoki J, Tateishi Y, Cummings CL, Cheng-Ching E, Ruggieri P, Hussain MS, and Uchino K
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Logistic Models, Male, Multivariate Analysis, Odds Ratio, Predictive Value of Tests, Prognosis, Risk Factors, Severity of Illness Index, Stroke diagnostic imaging, Stroke physiopathology, Stroke therapy, Cerebral Angiography methods, Cerebrovascular Circulation, Collateral Circulation, Diffusion Magnetic Resonance Imaging, Perfusion Imaging methods, Stroke diagnosis, Tomography, X-Ray Computed
- Abstract
Background: We investigated whether a computed tomography (CT)-based score could predict a large infarct (≥ 80 mL) on early diffusion-weighted magnetic resonance imaging (DWI)., Methods: Acute stroke patients considered for endovascular therapy within 8 hours of the onset of symptoms were included. The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was determined on noncontrast CT and computed tomography angiography source images (CTA-SI). Limited collateral flow was defined as less than 50% collateral filling on CTA-SI., Results: Fifty-six patients were analyzed. National Institutes of Health Stroke Scale score was 20 (15-24) in the large infarct group and 16 (11-20) in the small infarct group (P = .049). ASPECTS on noncontrast CT and CTA-SI was 5 (3-8) and 3 (2-6) in the large infarct group and 9 (8-10) and 8 (7-9) in the small infarct group (both P < .001), respectively. Limited collateral flow was frequent in the large infarct group than in the small infarct group (92% vs. 11%, P < .001). Multivariate analysis found that CTA-SI ASPECTS less than or equal to 5 (odds ratio [OR], 40.55; 95% confidence interval [CI], 1.10-1493.44; P = .044) and limited collateral flow (OR, 114.64; 95% CI, 1.93-6812.79; P = .023) were associated with a large infarct. Absence of ASPECTS less than or equal to 5 and limited collateral flow on CTA-SI predicted absence of a large infarct with a sensitivity of .89, specificity of 1.00, positive predictive value of 1.00, and negative predictive value of .71., Conclusions: Assessment of ASPECTS and collateral flow on CTA-SI may be able to exclude a patient with large infarct on early DWI., (Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
- Full Text
- View/download PDF