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Malignant CTA collateral profile is highly specific for large admission DWI infarct core and poor outcome in acute
L C S Souza1, A J Yoo, Z A Chaudhry
1Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114-9567, USA.
Insights
CTA collaterals correlate with stroke lesion size. A malignant collateral profile on CTA is highly specific for large DWI lesion volumes and poor outcomes in acute ischemic stroke patients.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Large DWI lesion volumes in acute ischemic stroke (AIS) correlate with poor patient outcomes.
- Assessing infarct size early is crucial for treatment decisions and prognosis.
Purpose of the Study:
- To determine if CTA collaterals correlate with admission DWI lesion volumes in AIS patients with proximal occlusions.
- To evaluate if a CTA collateral profile can specifically identify large DWI volumes.
Main Methods:
- 197 patients with AIS and M1/ICA occlusions were analyzed.
- DWI lesion volumes were segmented; CTA collaterals were scored (CS).
- ROC analysis assessed CS accuracy for predicting DWI volumes >100 mL.
Main Results:
- A negative correlation was found between CTA CS and DWI lesion volume (ρ = -0.54).
- CTA CS accurately discriminated large DWI volumes (AUC = 0.84).
- A malignant collateral profile (CS=0) showed 97.6% specificity for DWI >100 mL and predicted worse outcomes.
Conclusions:
- CTA collaterals correlate with admission DWI infarct size in AIS with proximal artery occlusions.
- A malignant collateral profile is a highly specific indicator of large infarcts and poor functional outcomes.
Background And Purpose:
Large admission DWI lesion volumes are associated with poor outcomes despite acute stroke treatment. The primary aims of our study were to determine whether CTA collaterals correlate with admission DWI lesion volumes in patients with AIS with proximal occlusions, and whether a CTA collateral profile could identify large DWI volumes with high specificity.
Materials And Methods:
We studied 197 patients with AIS with M1 and/or intracranial ICA occlusions. We segmented admission and follow-up DWI lesion volumes, and categorized CTA collaterals by using a 5-point CS system. ROC analysis was used to determine CS accuracy in predicting DWI lesion volumes >100 mL. Patients were dichotomized into 2 categories: CS = 0 (malignant profile) or CS>0. Univariate and multivariate analyses were performed to compare imaging and clinical variables between these 2 groups.
Results:
There was a negative correlation between CS and admission DWI lesion volume (ρ = -0.54, P < .0001). ROC analysis revealed that CTA CS was a good discriminator of DWI lesion volume >100 mL (AUC = 0.84, P < .001). CS = 0 had 97.6% specificity and 54.5% sensitivity for DWI volume >100 mL. CS = 0 patients had larger mean admission DWI volumes (165.8 mL versus 32.7 mL, P < .001), higher median NIHSS scores (21 versus 15, P < .001), and were more likely to become functionally dependent at 3 months (95.5% versus 64.0%, P = .003). Admission NIHSS score was the only independent predictor of a malignant CS (P = .007).
Conclusions:
In patients with AIS with PAOs, CTA collaterals correlate with admission DWI infarct size. A malignant collateral profile is highly specific for large admission DWI lesion size and poor functional outcome.
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