Thrombus length discrepancy on dual-phase CT can predict clinical outcome in acute ischemic stroke
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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 (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].
The presence of thrombus length discrepancy on dual-phase CT may be a useful predictor of unfavourable clinical outcome in acute M1 occlusion patients.
• 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.
KeywordsBrain Infarction Stroke Neuroimaging Tomography, X-Ray computed Middle cerebral artery
Contrast enhanced CT
Non-contrast enhanced CT
Digital subtraction angiography
Trial of Org 10172 in Acute Stroke Treatment
Modified Rankin scale score
Alberta Stroke Program Early CT Score
Maximum intensity projection
Thrombolysis in cerebral infarction
National Institutes of Health stroke scale
Tissue plasminogen activator
The scientific guarantor of this publication is Seung-Koo Lee. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. The institutional review board of Yonsei University Health System approved this study and granted a waiver of consent. Some study subjects (n = 34/48) have been previously reported in ‘Dual-phase CT collateral score: a predictor of clinical outcome in patients with acute ischemic stroke. PLoS One 9:e107379’. However, an additional 14 patients were included for this study and the primary aim of the two studies are different. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.
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