Automated CT Perfusion Prediction of Large Vessel Acute Stroke from Intracranial Atherosclerotic Disease.

Q1 Medicine

Interventional Neurology Pub Date : 2018-10-01 Epub Date: 2018-05-17 DOI:10.1159/000487335

Diogo C Haussen, Mehdi Bouslama, Seena Dehkharghani, Jonathan A Grossberg, Nicolas Bianchi, Meredith Bowen, Michael R Frankel, Raul G Nogueira

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引用次数: 16

Abstract

Background and purpose: We have observed that large vessel occlusion acute strokes (LVOS) due to intracranial atherosclerotic disease (ICAD) present with more benign CT perfusion (CTP) profiles, which we presume to potentially represent enhanced collateralization compared to embolic LVOS. We aim to determine if CTP profiles can predict ICAD in LVOS.

Methods: Retrospective review of a prospectively collected interventional stroke database from September 2010 to March 2015. Patients with intracranial ICA/MCA-M1/M2 occlusions and CTP were dichotomized into ICAD versus non-ICAD etiologies. Ischemic core (relative cerebral blood flow < 30%) and hypoperfusion volumes were estimated by automated CTP.

Results: A total of 250 patients met the inclusion criteria, comprised of 21 (8%) ICAD and 229 non-ICAD etiologies. Baseline characteristics were similar between groups, except for higher HbA1c levels (p < 0.01), LDL cholesterol (p < 0.01), systolic blood pressure (p < 0.01), and lower rate of atrial fibrillation (p < 0.01) in ICAD patients. There were no significant differences in volumes of baseline ischemic core (p = 0.54) among groups. ICAD patients had smaller Tmax > 4 s, Tmax > 6 s, and Tmax > 10 s absolute lesions, and a higher ratio of Tmax > 4 s/Tmax > 6 s volumes (median 2 [1.6-2.3] vs. 1.6 [1.4-2.0]; p = 0.02). A Tmax > 4 s/Tmax > 6 s ratio ≥2 showed specificity = 73%/sensitivity = 52% for ICAD and was observed in 47.6% of ICAD versus 26.1% of non-ICAD patients (p = 0.07). Clinical outcomes were comparable amongst groups. Multivariate logistic regression revealed that Tmax > 4 s/Tmax > 6 s ratio ≥2 (OR 3.75, 95% CI 1.05-13.14, p = 0.04), higher LDL cholesterol (OR 1.1, 95% CI 1.01-1.03, p = 0.01), and higher systolic pressure (OR 1.03, 95% CI 1.01-1.04, p = 0.01) were independently associated with ICAD.

Conclusion: An automated CTP Tmax > 4 s/Tmax > 6 s ratio ≥2 profile was found independently associated with underlying ICAD LVOS.

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颅内动脉粥样硬化性疾病引起的大血管急性卒中的自动CT灌注预测。

背景和目的:我们观察到，颅内动脉粥样硬化性疾病(ICAD)引起的大血管闭塞性急性卒中(LVOS)表现出更多的良性CT灌注(CTP)特征，我们认为这可能代表与栓塞性LVOS相比侧脉化增强。我们的目的是确定CTP谱是否可以预测LVOS的ICAD。方法:回顾性分析2010年9月至2015年3月前瞻性收集的卒中介入数据库。颅内ICA/MCA-M1/M2闭塞和CTP患者分为ICAD和非ICAD病因。通过自动CTP估计缺血核心(相对脑血流量< 30%)和低灌注体积。结果:共有250例患者符合纳入标准，包括21例(8%)ICAD和229例非ICAD病因。除ICAD患者HbA1c水平升高(p < 0.01)、LDL胆固醇水平升高(p < 0.01)、收缩压升高(p < 0.01)、房颤发生率降低(p < 0.01)外，各组间基线特征相似。各组基线缺血核体积差异无统计学意义(p = 0.54)。ICAD患者Tmax > 4 s、Tmax > 6 s、Tmax > 10 s绝对病灶较小，Tmax > 4 s/Tmax > 6 s体积比值较高(中位数2 [1.6-2.3]vs. 1.6 [1.4-2.0];P = 0.02)。Tmax > 4 s/Tmax > 6 s比值≥2对ICAD的特异性为73%/敏感性为52%，ICAD患者的特异性为47.6%，非ICAD患者的特异性为26.1% (p = 0.07)。各组间临床结果具有可比性。多因素logistic回归分析显示，Tmax > 4 s/Tmax > 6 s比值≥2 (OR 3.75, 95% CI 1.05 ~ 13.14, p = 0.04)、较高的LDL胆固醇(OR 1.1, 95% CI 1.01 ~ 1.03, p = 0.01)、较高的收缩压(OR 1.03, 95% CI 1.01 ~ 1.04, p = 0.01)与ICAD独立相关。结论:自动CTP Tmax > 4 s/Tmax > 6 s比值≥2与ICAD基础LVOS独立相关。

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Interventional Neurology CLINICAL NEUROLOGY-

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