Cortical vein opacification measurement using hounsfield unit values is a predictor for outcome in anterior...

In acute ischemic stroke (AIS) patients, the cortical vein opacification on computed tomographic angiography (CTA) imaging is usually asymmetric. We aimed to explore the correlation between CT perfusion parameters and cortical vein opacification evaluated by Hounsfield unit (HU) values, which is more accurately, and compare the predictive ability between them for outcome in AIS.

Patients with AIS obtained within 24 h after onset from June 2023 to January 2024 were reviewed. Opacification of the cortical vein of Labbé, sphenoparietal sinus, and the Trolard vein was measured on CTA imaging using HU. Then HU ratio (rHU) was calculated by dividing the affected side by the controlateral side (rHU = HU-affected/HU-control). The sum of rHU of three cortical veins opacification (CVOR, CVOR = rHU_Labbé+ rHU_{sphenoparietal sinus} + rHU _{Trolard vein}) was calculated. The correlations between CVOR and CT perfusion parameters, hypoperfusion and ischemic core volume, were explored. Outcome was assessed at 90 days using the modified Rankin Scale (mRS), a standardized measure of disability ranging from 0 (no symptoms) to 6 (death). An mRS score of 2 or less is considered as functional outcome.

A total of 143 patients (mean age, 67.3 ± 12.5 years; 106 men) were included. We found that CVOR had a strong negative correlation with hypoperfusion volume (r = -0.759, P < 0.001) and had a moderate negative correlation with ischemic core volume (r = -0.517, P < 0.001). Receiver operating characteristic curve analysis revealed CVOR performed better than hypoperfusion volume (area under the curve [AUC], 0.784 vs 0.711; P = 0.008) and ischemic core volume (AUC, 0.784 vs 0.693; P = 0.02) in predicting the favorable 90-day mRS. Multivariable analysis showed CVOR was an independent predictor for poor outcome after adjusting for confounding factors [odds ratio 0.06 (0.02-0.32), p < 0.001].

Cortical vein opacification evaluated by HU values, had a strong negative correlation with hypoperfusion volume, and was also a novel independent predictor for clinical outcome.