Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke

A M M Boers, R Sales Barros, I G H Jansen, O A Berkhemer, L F M Beenen, B K Menon, D W J Dippel, A van der Lugt, W H van Zwam, Y B W E M Roos, R J van Oostenbrugge, C H Slump, C B L M Majoie, H A Marquering, MR CLEAN Investigators

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND AND PURPOSE: Many studies have emphasized the relevance of collateral flow in patients presenting with acute ischemic stroke. Our aim was to evaluate the relationship of the quantitative collateral score on baseline CTA with the outcome of patients with acute ischemic stroke and test whether the timing of the CTA acquisition influences this relationship.

MATERIALS AND METHODS: From the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) data base, all baseline thin-slice CTA images of patients with acute ischemic stroke with intracranial large-vessel occlusion were retrospectively collected. The quantitative collateral score was calculated as the ratio of the vascular appearance of both hemispheres and was compared with the visual collateral score. Primary outcomes were 90-day mRS score and follow-up infarct volume. The relation with outcome and the association with treatment effect were estimated. The influence of the CTA acquisition phase on the relation of collateral scores with outcome was determined.

RESULTS: A total of 442 patients were included. The quantitative collateral score strongly correlated with the visual collateral score (ρ = 0.75) and was an independent predictor of mRS (adjusted odds ratio = 0.81; 95% CI, .77-.86) and follow-up infarct volume (exponent β = 0.88; P < .001) per 10% increase. The quantitative collateral score showed areas under the curve of 0.71 and 0.69 for predicting functional independence (mRS 0-2) and follow-up infarct volume of >90 mL, respectively. We found significant interaction of the quantitative collateral score with the endovascular therapy effect in unadjusted analysis on the full ordinal mRS scale (P = .048) and on functional independence (P = .049). Modification of the quantitative collateral score by acquisition phase on outcome was significant (mRS: P = .004; follow-up infarct volume: P < .001) in adjusted analysis.

CONCLUSIONS: Automated quantitative collateral scoring in patients with acute ischemic stroke is a reliable and user-independent measure of the collateral capacity on baseline CTA and has the potential to augment the triage of patients with acute stroke for endovascular therapy.

Original languageEnglish
Pages (from-to)1074-1082
Number of pages9
JournalAmerican Journal of Neuroradiology
Volume39
Issue number6
DOIs
Publication statusPublished - Jun 2018

Cite this

Boers, A M M ; Sales Barros, R ; Jansen, I G H ; Berkhemer, O A ; Beenen, L F M ; Menon, B K ; Dippel, D W J ; van der Lugt, A ; van Zwam, W H ; Roos, Y B W E M ; van Oostenbrugge, R J ; Slump, C H ; Majoie, C B L M ; Marquering, H A ; MR CLEAN Investigators. / Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke. In: American Journal of Neuroradiology. 2018 ; Vol. 39, No. 6. pp. 1074-1082.
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title = "Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke",
abstract = "BACKGROUND AND PURPOSE: Many studies have emphasized the relevance of collateral flow in patients presenting with acute ischemic stroke. Our aim was to evaluate the relationship of the quantitative collateral score on baseline CTA with the outcome of patients with acute ischemic stroke and test whether the timing of the CTA acquisition influences this relationship.MATERIALS AND METHODS: From the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) data base, all baseline thin-slice CTA images of patients with acute ischemic stroke with intracranial large-vessel occlusion were retrospectively collected. The quantitative collateral score was calculated as the ratio of the vascular appearance of both hemispheres and was compared with the visual collateral score. Primary outcomes were 90-day mRS score and follow-up infarct volume. The relation with outcome and the association with treatment effect were estimated. The influence of the CTA acquisition phase on the relation of collateral scores with outcome was determined.RESULTS: A total of 442 patients were included. The quantitative collateral score strongly correlated with the visual collateral score (ρ = 0.75) and was an independent predictor of mRS (adjusted odds ratio = 0.81; 95{\%} CI, .77-.86) and follow-up infarct volume (exponent β = 0.88; P < .001) per 10{\%} increase. The quantitative collateral score showed areas under the curve of 0.71 and 0.69 for predicting functional independence (mRS 0-2) and follow-up infarct volume of >90 mL, respectively. We found significant interaction of the quantitative collateral score with the endovascular therapy effect in unadjusted analysis on the full ordinal mRS scale (P = .048) and on functional independence (P = .049). Modification of the quantitative collateral score by acquisition phase on outcome was significant (mRS: P = .004; follow-up infarct volume: P < .001) in adjusted analysis.CONCLUSIONS: Automated quantitative collateral scoring in patients with acute ischemic stroke is a reliable and user-independent measure of the collateral capacity on baseline CTA and has the potential to augment the triage of patients with acute stroke for endovascular therapy.",
author = "Boers, {A M M} and {Sales Barros}, R and Jansen, {I G H} and Berkhemer, {O A} and Beenen, {L F M} and Menon, {B K} and Dippel, {D W J} and {van der Lugt}, A and {van Zwam}, {W H} and Roos, {Y B W E M} and {van Oostenbrugge}, {R J} and Slump, {C H} and Majoie, {C B L M} and Marquering, {H A} and {MR CLEAN Investigators} and JCJ Bot",
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Boers, AMM, Sales Barros, R, Jansen, IGH, Berkhemer, OA, Beenen, LFM, Menon, BK, Dippel, DWJ, van der Lugt, A, van Zwam, WH, Roos, YBWEM, van Oostenbrugge, RJ, Slump, CH, Majoie, CBLM, Marquering, HA & MR CLEAN Investigators 2018, 'Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke' American Journal of Neuroradiology, vol. 39, no. 6, pp. 1074-1082. https://doi.org/10.3174/ajnr.A5623

Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke. / Boers, A M M; Sales Barros, R; Jansen, I G H; Berkhemer, O A; Beenen, L F M; Menon, B K; Dippel, D W J; van der Lugt, A; van Zwam, W H; Roos, Y B W E M; van Oostenbrugge, R J; Slump, C H; Majoie, C B L M; Marquering, H A; MR CLEAN Investigators.

In: American Journal of Neuroradiology, Vol. 39, No. 6, 06.2018, p. 1074-1082.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Value of Quantitative Collateral Scoring on CT Angiography in Patients with Acute Ischemic Stroke

AU - Boers, A M M

AU - Sales Barros, R

AU - Jansen, I G H

AU - Berkhemer, O A

AU - Beenen, L F M

AU - Menon, B K

AU - Dippel, D W J

AU - van der Lugt, A

AU - van Zwam, W H

AU - Roos, Y B W E M

AU - van Oostenbrugge, R J

AU - Slump, C H

AU - Majoie, C B L M

AU - Marquering, H A

AU - MR CLEAN Investigators

AU - Bot, JCJ

N1 - © 2018 by American Journal of Neuroradiology.

PY - 2018/6

Y1 - 2018/6

N2 - BACKGROUND AND PURPOSE: Many studies have emphasized the relevance of collateral flow in patients presenting with acute ischemic stroke. Our aim was to evaluate the relationship of the quantitative collateral score on baseline CTA with the outcome of patients with acute ischemic stroke and test whether the timing of the CTA acquisition influences this relationship.MATERIALS AND METHODS: From the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) data base, all baseline thin-slice CTA images of patients with acute ischemic stroke with intracranial large-vessel occlusion were retrospectively collected. The quantitative collateral score was calculated as the ratio of the vascular appearance of both hemispheres and was compared with the visual collateral score. Primary outcomes were 90-day mRS score and follow-up infarct volume. The relation with outcome and the association with treatment effect were estimated. The influence of the CTA acquisition phase on the relation of collateral scores with outcome was determined.RESULTS: A total of 442 patients were included. The quantitative collateral score strongly correlated with the visual collateral score (ρ = 0.75) and was an independent predictor of mRS (adjusted odds ratio = 0.81; 95% CI, .77-.86) and follow-up infarct volume (exponent β = 0.88; P < .001) per 10% increase. The quantitative collateral score showed areas under the curve of 0.71 and 0.69 for predicting functional independence (mRS 0-2) and follow-up infarct volume of >90 mL, respectively. We found significant interaction of the quantitative collateral score with the endovascular therapy effect in unadjusted analysis on the full ordinal mRS scale (P = .048) and on functional independence (P = .049). Modification of the quantitative collateral score by acquisition phase on outcome was significant (mRS: P = .004; follow-up infarct volume: P < .001) in adjusted analysis.CONCLUSIONS: Automated quantitative collateral scoring in patients with acute ischemic stroke is a reliable and user-independent measure of the collateral capacity on baseline CTA and has the potential to augment the triage of patients with acute stroke for endovascular therapy.

AB - BACKGROUND AND PURPOSE: Many studies have emphasized the relevance of collateral flow in patients presenting with acute ischemic stroke. Our aim was to evaluate the relationship of the quantitative collateral score on baseline CTA with the outcome of patients with acute ischemic stroke and test whether the timing of the CTA acquisition influences this relationship.MATERIALS AND METHODS: From the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) data base, all baseline thin-slice CTA images of patients with acute ischemic stroke with intracranial large-vessel occlusion were retrospectively collected. The quantitative collateral score was calculated as the ratio of the vascular appearance of both hemispheres and was compared with the visual collateral score. Primary outcomes were 90-day mRS score and follow-up infarct volume. The relation with outcome and the association with treatment effect were estimated. The influence of the CTA acquisition phase on the relation of collateral scores with outcome was determined.RESULTS: A total of 442 patients were included. The quantitative collateral score strongly correlated with the visual collateral score (ρ = 0.75) and was an independent predictor of mRS (adjusted odds ratio = 0.81; 95% CI, .77-.86) and follow-up infarct volume (exponent β = 0.88; P < .001) per 10% increase. The quantitative collateral score showed areas under the curve of 0.71 and 0.69 for predicting functional independence (mRS 0-2) and follow-up infarct volume of >90 mL, respectively. We found significant interaction of the quantitative collateral score with the endovascular therapy effect in unadjusted analysis on the full ordinal mRS scale (P = .048) and on functional independence (P = .049). Modification of the quantitative collateral score by acquisition phase on outcome was significant (mRS: P = .004; follow-up infarct volume: P < .001) in adjusted analysis.CONCLUSIONS: Automated quantitative collateral scoring in patients with acute ischemic stroke is a reliable and user-independent measure of the collateral capacity on baseline CTA and has the potential to augment the triage of patients with acute stroke for endovascular therapy.

U2 - 10.3174/ajnr.A5623

DO - 10.3174/ajnr.A5623

M3 - Article

VL - 39

SP - 1074

EP - 1082

JO - American Journal of Neuroradiology

JF - American Journal of Neuroradiology

SN - 0195-6108

IS - 6

ER -