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Single-phase CT angiography: collateral grade is independent of scan weighting

  • Daniel-Alexandre Bisson
  • David Mahmoudian
  • Anwar S. Shatil
  • Ghouth Waggass
  • Liying Zhang
  • Christopher Levi
  • Neil J. Spratt
  • Longting Lin
  • David Liebeskind
  • Mark Parsons
  • Andrew Bivard
  • Richard I. Aviv
Diagnostic Neuroradiology

Abstract

Purpose

Collateral grading may vary on single-phase CTA (sCTA) depending on whether the CTA is arterial (A), arteriovenous (AV), or venous (V) weighted. We studied the impact of sCTA weighting on collateral grading using the Tan, MAAS, and Menon methods, and their ability to predict infarct and clinical outcome hypothesizing that AV-weighted sCTA should better predict these outcomes.

Methods

Multicenter retrospective analysis of 212 patients undergoing baseline CTP/sCTA. sCTA weighting was determined by comparing ICA to torcula AV ratios with those from concomitant CTP time-density curves at peak arterial or venous contrast attenuation. A generalized linear mixed model investigated the predictive value for infarct volume or 90-day mRS of the three collateral scores stratified by sCTA weighting and adjusting for age, sex, clot burden score (CBS), and NIHSS. Bayesian information criterion (BIC) differences were calculated between the null and fitted models.

Results

Mean age, baseline median NIHSS, ASPECTS, and onset to treatment time were 69.89 ± 14.45, 13 (6–18), 10 (8–10), and 128 (66–181) minutes. sCTA scans were AV-weighted in 137/212 (65%) and A-weighted in 73 (34%). No association was demonstrated between sCTA weighting, hospital site, and sCTA technique. All collateral scores were related to infarct volume irrespective of sCTA weighting, with greatest fit with the regional leptomeningeal score (BIC 18.29, p = 0.0001). No association was shown between sCTA weighting, collateral grade, and clinical outcome.

Conclusion

sCTA weighting did not significantly impact collateral grade using three common collateral scores or their ability to predict final infarct.

Keywords

Single-phase CTA Multiphase CTA Dynamic CTA Collaterals Stroke 

Notes

Compliance with ethical standards

Funding

This project was funded by a National Health and Medical Research Council Australia Partnership Project Grant (APP1013719). NS is funded by a National Health and Medical Research Council/National Heart Foundation co-funded Career Development/Future Leader Fellowship (APPS1110629/100827). CL is funded by a National Health and Medical Research Council Practitioner Fellowship (APP 1043913).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

234_2018_2105_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 16 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Daniel-Alexandre Bisson
    • 1
    • 2
  • David Mahmoudian
    • 1
    • 2
  • Anwar S. Shatil
    • 1
    • 2
  • Ghouth Waggass
    • 1
    • 2
  • Liying Zhang
    • 1
    • 2
  • Christopher Levi
    • 3
  • Neil J. Spratt
    • 3
  • Longting Lin
    • 3
  • David Liebeskind
    • 4
  • Mark Parsons
    • 3
  • Andrew Bivard
    • 3
  • Richard I. Aviv
    • 1
    • 2
  1. 1.Department of Medical Imaging, Division of NeuroradiologySunnybrook Health Sciences CentreTorontoCanada
  2. 2.Department of Medical ImagingUniversity of TorontoTorontoCanada
  3. 3.Department of Neurology, John Hunter HospitalUniversity of NewcastleNewcastleAustralia
  4. 4.UCLA Stroke Center, UCLA Neuroscience Research BuildingLos AngelesUSA

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