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

Bisson, Daniel-Alexandre; Mahmoudian, David; Shatil, Anwar S.; Waggass, Ghouth; Zhang, Liying; Levi, Christopher; Spratt, Neil J; Lin, Longting; Liebeskind, David S; Bivard, Andrew; Aviv, Richard I.

doi:10.1007/s00234-018-2105-2

Cited by 8 publications

(5 citation statements)

References 30 publications

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“…Occlusion type based on CTA was another applicable method for determining ICAS-O before thrombectomy. However, conventional CTA imaging may vary depending on whether the scan phase is arterial, arteriovenous, or venous-weighted (35,36). Unequal CTA quality would make ICAS-O identification difficult.…”

Section: Discussionmentioning

confidence: 99%

Jet-Like Appearance in Angiography as a Predictive Image Marker for the Occlusion of Intracranial Atherosclerotic Stenosis

et al. 2020

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Introduction: Identifying intracranial atherosclerotic stenosis-related occlusion (ICAS-O) in acute ischemic stroke has important clinical significance. Correct identification would help operators devise an optimal recanalization strategy. However, it is often hard to make accurate judgments in emergency situations before thrombectomy. Here, we propose a new image marker for ICAS-O based on the appearance of occluded vessels on baseline digital subtraction angiography. Materials and Methods:We retrospectively reviewed patients with acute ischemic stroke who underwent endovascular therapy from August 2017 to February 2020 at our center. ICAS-O was identified by residual focal stenosis at occluded vessels after successful recanalization. The jet-like appearance was defined as appearance of pencil-tip-like or line-linked contrast filling of the occlusion edge. A non-jet-like appearance was defined as appearance of convex, concave, or flat edge contrast filling. The proportion of jet-like appearance in different occlusion etiologies and occluded vessels was determined. The diagnostic value of jet-like appearance for ICAS-O was assessed.Results: A total of 164 patients diagnosed with ICAS-O were enrolled. Jet-like appearance was detected in 34 (20.7%) patients with younger age (68.0 ± 11.9 years vs. 62.7 ± 10.2, p = 0.019), patients with lower baseline NIHSS scores (16.6 ± 7.1 vs. 12.4 ± 6.5, p = 0.002) and patients with more past stroke or transit ischemic events (31.4 vs. 13.2%, p = 0.011). ICAS-O rate was higher in the jet-like appearance group (82.9 vs. 8.5%, p < 0.001), and rescue methods were more frequently used (74.3 vs. 12.4%, p < 0.001). Jet-like appearance was mostly found at the origin of the middle cerebral artery (MCA) (44.1%), followed by the first segment trunk of MCA (20.6%) and internal carotid artery (ICA) supraclinoid (11.8%). Logistic regression showed that jet-like appearance was independently associated with 95% CI (17.966,1,819.733), p < 0.001]. The sensitivity, specificity, and accuracy values for predicting ICAS-O was 96, 78, and 83%. Jin et al. An Image Marker of ICAS-O Conclusion:The jet-like appearance on the angiogram was an image marker for ICAS-O, with relatively high sensitivity and specificity, which could help operators predict underlying intracranial atherosclerotic stenosis in a timely manner and choose the optimal intervention strategy during endovascular therapy.

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Section: Discussionmentioning

confidence: 99%

Jet-Like Appearance in Angiography as a Predictive Image Marker for the Occlusion of Intracranial Atherosclerotic Stenosis

et al. 2020

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“…7,21 In contrast, one study reported that sCTA weighting had no significant impact on collateral grading. 6 However, in that study, the majority of arterial-weighted scans were close to arterio-venous-weighting and the authors regarded the concern of early arterial-weighted scans as more theoretical. However, in the present study, 23.3% of sCTA were classified as early arterial-weighted.…”

Section: Discussionmentioning

confidence: 89%

“…2 However, collateral assessment on baseline CTA is not uniform across studies. [6][7][8] The aim of this preplanned pooled analysis of patient-level data from the HERMES collaboration was to compare 3 different collateral scores (CSs) assessed on baseline CTA in their ability to predict functional outcome in patients with acute ischemic stroke eligible for EVT. Furthermore, the impact of CTA modality (single-phase CTA and time-resolved CTA) on collateral assessment was investigated.…”

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confidence: 99%

Comparison of Three Scores of Collateral Status for Their Association With Clinical Outcome: The HERMES Collaboration

Gensicke

Al-Ajlan

Fladt

et al. 2022

Stroke

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Background: Leptomeningeal collateral status on baseline computed tomographic angiography (CTA) is associated with clinical outcome after acute ischemic stroke treatment. However, assessment of collateral status is not uniform. To compare 3 different CTA collateral scores (CS) and imaging techniques about their association with clinical outcome. Methods: Pooled analysis of patient-level data from the Highly Effective Reperfusion Using Multiple Endovascular Devices collaboration. Patients with large vessel occlusion from 7 randomized controlled trials that compared endovascular thrombectomy with standard medical care were included. Three different CS (Tan CS, regional CS [rCS], and regional Alberta Stroke Program Early CT Score CS) and 2 imaging techniques (single-phase [sCTA] and multiphase/dynamic CTA) were evaluated. Functional independence (modified Rankin Scale score 0–2) at 3 months poststroke was the primary outcome. Furthermore, we assessed the effect of sCTA image acquisition time on collateral status assessment using an adjusted ordinal logistic regression model to obtain predicted values for the trichotomized rCS. Results: Among 1147 pooled patients, 948 (82.7%) had sCTA and 199 (17.3%) multiphase/dynamic CTA as baseline angiography. With all 3 collateral scales, better CSs were associated with better 3-month functional outcome. With sCTA images, the rCS (area under the curve [AUC] 0.63) and regional Alberta Stroke Program Early CT Score CS (AUC 0.62) better predicted functional outcome than the Tan CS (AUC 0.60, respectively; P <0.001 and P =0.02). With multiphase/dynamic CTA images, all collateral scales performed similarly in predicting functional outcome (rCS [AUC 0.61]; regional Alberta Stroke Program Early CT Score CS [AUC 0.61] versus Tan CS [AUC 0.61], respectively; P =0.93 and P =0.91). Overall, no endovascular thrombectomy treatment effect modification by collateral status (rCS) was demonstrated ( P =0.41). sCTA timing independently influenced CS assessment. On earlier timed sCTA, the predicted proportions of scans with poor collaterals was higher and vice versa. Conclusions: In this data set of highly selected patients with stroke, using a regional CS on sCTA likely allows for the most accurate prediction of functional outcome while on time-resolved CTA, the type of CS did not matter. Patients across all collateral grades benefit from endovascular thrombectomy. sCTA timing independently influenced CS assessment.

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“…This is not only a challenge in everyday clinical practice but is ultimately a quality marker. The contrast phase of a single-phase CTA does, however, not necessarily affect collateral grading or their ability to predict final infarct, if it is arterial or arteriovenous weighted [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Variability of acquisition phase of computed tomography angiography in acute ischemic stroke in a real-world scenario

et al. 2021

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Objectives The informative value of computed tomography angiography (CTA) depends on the contrast phase in the vessels which may differ depending on the level of local expertise. Methods We retrospectively measured vessel contrast density from CTA scans in patients presenting with acute ischemic stroke to a comprehensive stroke center (CSC) or to one of eight primary stroke centers (PSC). CTAs were classified into arterial or venous phases as well as into 1 of 5 phases (early arterial, peak arterial, equilibrium, peak venous, and late venous). Results Overall, n = 871 CTAs (CSC: n = 431 (49.5%); PSC: n = 440 (50.5%)) were included in the final analysis. A higher venous than arterial contrast density at the level of the circle of Willis was only rarely observed (overall n = 13 (1.5%); CSC: n = 3/431 (0.7%); PCS: n = 10/440 (2.3%); p = 0.09). CTAs acquired in the CSC showed more often an early arterial contrast phase (CSC: n = 371 (86.1%); PSC: n = 153 (34.8%), p < 0.01). Equilibrium contrast phase, i.e., a slightly stronger arterial contrast with clear venous contrast filling, was more frequent in CTAs from the PSCs (CSC: n = 6 (1.4%); PSC: n = 47 (10.7%); p < 0.01). Conclusions Despite different technical equipment and examination protocols, the overall number of CTAs with venous contrast was low and did not differ between the CSC and the PCSs. Differences between the further differentiated contrast phases indicate potential for further improvement of CTA acquisition protocols. Key Points • Despite different technical equipment and examination protocols in the diagnostic workup of acute ischemic stroke, the total number of computed tomography angiography (CTA) with venous contrast was low (n = 13/871; 1.5%). • A higher venous than arterial contrast density at the level of the circle of Willis was not more frequent in CTAs from the centers with a high patient volume (comprehensive stroke center) compared to the hospital with lower patient volume (primary stroke centers). • Differences between the further differentiated contrast phases indicate that there is potential for further improvement of CTA acquisition protocols.

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

Cited by 8 publications

References 30 publications

Jet-Like Appearance in Angiography as a Predictive Image Marker for the Occlusion of Intracranial Atherosclerotic Stenosis

Jet-Like Appearance in Angiography as a Predictive Image Marker for the Occlusion of Intracranial Atherosclerotic Stenosis

Comparison of Three Scores of Collateral Status for Their Association With Clinical Outcome: The HERMES Collaboration

Variability of acquisition phase of computed tomography angiography in acute ischemic stroke in a real-world scenario

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