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

Title
Thrombus length discrepancy on dual-phase CT can predict clinical outcome in acute ischemic stroke
Authors
Park, MinaKim, Kyung-eunShin, Na-YoungLee, Seung-KooLim, Soo MeeSong, DongbeomHeo, Ji HoeKim, Jin WooOh, Se Won
Ewha Authors
임수미신나영
SCOPUS Author ID
임수미scopus; 신나영scopus
Issue Date
2016
Journal Title
EUROPEAN RADIOLOGY
ISSN
0938-7994JCR Link1432-1084JCR Link
Citation
vol. 26, no. 7, pp. 2215 - 2222
Keywords
Brain InfarctionStrokeNeuroimagingTomography, X-Ray computedMiddle cerebral artery
Publisher
SPRINGER
Indexed
SCI; SCIE; SCOPUS WOS scopus
Abstract
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. 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. 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 (kappa = 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]. The presence of thrombus length discrepancy on dual-phase CT may be a useful predictor of unfavourable clinical outcome in acute M1 occlusion patients. aEuro cent Early arterial phase CTA may underestimate thrombus length. aEuro cent Thrombus length discrepancy grade reflects collateral status or presence of antegrade flow. aEuro cent Outcome prediction may be better with thrombus length grade than collateral score.
DOI
10.1007/s00330-015-4018-3
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의과대학 > 의학과 > Journal papers
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