Hyperattenuating Collateral Arteries and Accompanying Cortical Veins as Auxiliary Signs of M2 Occlusion on Dual-Phase CTA

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Neuroimaging Pub Date : 2025-06-07 DOI:10.1111/jon.70060

Alex Mortimer, Richard Flood, Sophie Dunkerton

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引用次数: 0

Abstract

Background and Purpose

M2 middle cerebral arterial (MCA) occlusions present a greater radiological challenge when compared to more proximal occlusions and additional signs aiding detection could be helpful. We routinely image patients with a dual-phase CT angiography (CTA) protocol, encompassing a bolus-tracked arterial/early and then delayed-phase (40-s post contrast injection) acquisition. We screened a 12-month period of our local thrombectomy database as a preliminary investigation into additional signs that can be gleaned to aid M2 occlusion diagnosis when imaged using this technique.

Methods

We reviewed the CTA and digital subtraction angiographic (DSA) imaging in 10 consecutive patients with M2 MCA occlusions who subsequently underwent thrombectomy.

Results

All patients showed the presence of hyperattenuating M3 and M4 vessels distal to the occlusion on delayed-phase but not early-phase CTA (despite venous opacification evident on the latter). Compared to the contralateral side, attenuation values were significantly elevated in these vessels (202.3 [23.9] vs. 108.5 [16.4] Hounsfield units [HU]; 95% confidence interval [CI] of difference: 69.7–117.9, p < 0.0001). Eight of 10 patients also showed associated ipsilateral hyperattenuating cortical veins; the attenuation difference compared to contralateral cortical veins was 263.5 (58.3) vs. 151 (16.7) HU, 95% CI: 69.0–156.0, p = 0.0005. Collateral appearance and washout were much brisker on DSA suggesting that the signs on delayed-phase CTA represent the retrograde accumulation of contrast material distal to the occlusion after multiple contrast passes with slowed resultant venous flow accounting for an accumulation on the venous side.

Conclusion

An additional phase at 40-s displays hyperattenuating distal arteries and cortical veins that could aid in occlusion detection.

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双期CTA显示侧支及伴随皮质静脉高衰减为M2闭塞的辅助征象

背景和目的与近端闭塞相比，M2脑中动脉（MCA）闭塞具有更大的放射学挑战，其他体征有助于检测。我们常规对患者进行双期CT血管造影（CTA）成像，包括动脉/早期和延迟期（注射造影剂后40秒）采集。我们筛选了12个月的局部取栓数据库，作为使用该技术成像时可以收集到的辅助M2闭塞诊断的其他征象的初步调查。方法回顾10例连续行血栓切除术的M2 MCA闭塞患者的CTA和数字减影血管造影（DSA）成像。结果所有患者在迟发期CTA上均可见闭塞远端高衰减的M3和M4血管，而在早期CTA上未见（尽管早期CTA上可见静脉混浊）。与对侧相比，这些血管的衰减值显著升高(202.3[23.9]比108.5 [16.4]Hounsfield单位[HU]；差异的95%置信区间[CI]: 69.7-117.9, p <；0.0001)。10例患者中有8例还显示相关的同侧皮质静脉过度衰减；与对侧皮质静脉相比，衰减差为263.5（58.3）比151 (16.7)HU, 95% CI: 69.0 ~ 156.0, p = 0.0005。DSA上侧支的外观和冲洗更加明显，提示延迟期CTA上的征象代表了多次造影剂通过后造影剂在闭塞远端逆行堆积，由此导致的静脉血流减慢，导致静脉侧堆积。结论40-s的另一个相位显示远端动脉和皮质静脉的超衰减，有助于闭塞检测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neuroimaging 医学-核医学

CiteScore

4.70

自引率

0.00%

发文量

117

审稿时长

6-12 weeks

期刊介绍： Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on: MRI CT Carotid Ultrasound and TCD SPECT PET Endovascular Surgical Neuroradiology Functional MRI Xenon CT and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!