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Asymmetry of medullary veins on multiphase CT-angiography in patients with acute ischemic stroke.
Journal of Stroke & Cerebrovascular Diseases ( IF 2.5 ) Pub Date : 2020-07-28 , DOI: 10.1016/j.jstrokecerebrovasdis.2020.105064
A A Drozdov 1 , R Javan 1 , C R Leon Guerrero 2 , A D Sparks 3 , M R Taheri 1
Affiliation  

Background

It was previously demonstrated that decreased cortical venous drainage is a predictive factor of poor clinical outcome in patients with an acute ischemic stroke. The aim of this investigation is to test the hypothesis that the decline in blood flow in medullary veins (MV) on CT angiogram (CTA) of patients with acute ischemic stroke (AIS) can also be predictive of clinical outcome.

Methods

We retrospectively reviewed a database of patients with AIS who were evaluated by multiphase CTA and enrolled individuals with AIS and evidence of occlusion of the intracranial internal carotid artery, the M1 or M2 segment of the middle cerebral artery, or combination of two occlusions. To characterize asymmetry of MV we used similar principle that was previously established for MV on SWI MR-images; asymmetry was defined was presence of 5 or more contrast opacified MV in one hemisphere as compared to the contralateral side. Clinical outcomes were evaluated by mRS in 90 days. The Fisher Exact test was used to examine the significance of the MV asymmetry. Odds ratio and interrater variability were calculated.

Results

66 patients with AIS were included. The presence of asymmetry in MV was associated with the higher frequency of poor clinical outcomes (84.6% vs 50.9%); the OR was 5.3. Interrater agreement in assessment on MV was moderate in our study (κ=0.55).

Conclusion

This study shows that (a) medullary veins can be reliably assessed on multiphase CTA, (b) in patients with AIS, asymmetric appearance of MV is associated with poor clinical outcome.



中文翻译:

急性缺血性卒中患者多相CT血管造影上的延髓静脉不对称性。

背景

先前已证明,急性缺血性卒中患者的皮质静脉引流减少是不良临床预后的预测因素。这项研究的目的是检验以下假设:急性缺血性卒中(AIS)患者的CT血管造影(CTA)上的髓静脉(MV)血流减少也可以预测临床结果。

方法

我们回顾性地回顾了通过多期CTA评估的AIS患者数据库,并招募了具有AIS的个人,并发现颅内颈动脉闭塞,大脑中动脉的M1或M2节段或两次闭塞的结合。为了表征MV的不对称性,我们使用了先前在SWI MR图像上为MV建立的相似原理。不对称定义为与对侧相比,一个半球中存在5个或更多的对比不透明MV。在90天内通过mRS评估了临床结局。Fisher精确检验用于检验MV不对称的重要性。计算赔率和人际变异性。

结果

纳入66例AIS患者。MV中不对称的存在与较差的临床结果发生频率较高有关(84.6%vs 50.9%);或为5.3。在我们的研究中,评估MV的评估者之间的一致性中等(κ = 0.55)。

结论

这项研究表明(a)可以通过多期CTA可靠地评估髓静脉,(b)AIS患者的MV外观不对称与临床预后不良相关。

更新日期:2020-07-28
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