The Prognostic Value of CT Angiography and CT Perfusion in Acute Ischemic Stroke

Cerebrovascular Diseases - Tập 40 Số 5-6 - Trang 258-269 - 2015
Tom van Seeters1, Geert Jan Biessels2, L. Jaap Kappelle2, Irene C. van der Schaaf1, Jan Willem Dankbaar1, Alexander D. Horsch1, J.M. Niesten1, Merel J.A. Luitse1, Charles B.L.M. Majoie3, Jan Albert Vos4, Wouter J. Schonewille5, Marianne AA van Walderveen4, Marieke J.H. Wermer6, Luciën E.M. Duijm4, Koos Keizer7, Joost Bot4, Marieke C. Visser8, Aad van der Lugt4, Diederik W.J. Dippel9, F.O. Kesselring4, Frederick J. A. Meijer10, Geert J. Lycklama à Nijeholt4, Jelis Boiten11, N. R. Jagannathan4, Paul L.M. de Kort12, Yvo B.W.E.M. Roos13, Ewoud J. van Dijk14, C.C. Pleiter15, Willem P.Th.M. Mali1, Yolanda van der Graaf16, Birgitta K. Velthuis1
1Department of Radiology
2Department of Neurology, Brain Center Rudolf Magnus, and
3Department of Radiology, Academic Medical Center, Departments of
4Radiology and
5Neurology, St. Antonius Hospital, Nieuwegein, Departments of
6Neurology, Leiden University Medical Center, Leiden, Departments of
7Neurology, Catharina Hospital, Eindhoven, Departments of
8Neurology, VU University Medical Center,
9Neurology, Erasmus MC University Medical Center,
10Neurology, Rijnstate Hospital, Arnhem, Departments of
11Neurology, Medical Center Haaglanden, The Hague, Departments of
12Neurology, St. Elisabeth Hospital, Tilburg,
13Department of Neurology, Academic Medical Center, Amsterdam, Departments of
14Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
15Department of Radiology, St. Franciscus Hospital, Rotterdam, Departments of
16Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht

Tóm tắt

<b><i>Background:</i></b> CT angiography (CTA) and CT perfusion (CTP) are important diagnostic tools in acute ischemic stroke. We investigated the prognostic value of CTA and CTP for clinical outcome and determined whether they have additional prognostic value over patient characteristics and non-contrast CT (NCCT). <b><i>Methods:</i></b> We included 1,374 patients with suspected acute ischemic stroke in the prospective multicenter Dutch acute stroke study. Sixty percent of the cohort was used for deriving the predictors and the remaining 40% for validating them. We calculated the predictive values of CTA and CTP predictors for poor clinical outcome (modified Rankin Scale score 3-6). Associations between CTA and CTP predictors and poor clinical outcome were assessed with odds ratios (OR). Multivariable logistic regression models were developed based on patient characteristics and NCCT predictors, and subsequently CTA and CTP predictors were added. The increase in area under the curve (AUC) value was determined to assess the additional prognostic value of CTA and CTP. Model validation was performed by assessing discrimination and calibration. <b><i>Results:</i></b> Poor outcome occurred in 501 patients (36.5%). Each of the evaluated CTA measures strongly predicted outcome in univariable analyses: the positive predictive value (PPV) was 59% for Alberta Stroke Program Early CT Score (ASPECTS) ≤7 on CTA source images (OR 3.3; 95% CI 2.3-4.8), 63% for presence of a proximal intracranial occlusion (OR 5.1; 95% CI 3.7-7.1), 66% for poor leptomeningeal collaterals (OR 4.3; 95% CI 2.8-6.6), and 58% for a >70% carotid or vertebrobasilar stenosis/occlusion (OR 3.2; 95% CI 2.2-4.6). The same applied to the CTP measures, as the PPVs were 65% for ASPECTS ≤7 on cerebral blood volume maps (OR 5.1; 95% CI 3.7-7.2) and 53% for ASPECTS ≤7 on mean transit time maps (OR 3.9; 95% CI 2.9-5.3). The prognostic model based on patient characteristics and NCCT measures was highly predictive for poor clinical outcome (AUC 0.84; 95% CI 0.81-0.86). Adding CTA and CTP predictors to this model did not improve the predictive value (AUC 0.85; 95% CI 0.83-0.88). In the validation cohort, the AUC values were 0.78 (95% CI 0.73-0.82) and 0.79 (95% CI 0.75-0.83), respectively. Calibration of the models was satisfactory. <b><i>Conclusions:</i></b> In patients with suspected acute ischemic stroke, admission CTA and CTP parameters are strong predictors of poor outcome and can be used to predict long-term clinical outcome. In multivariable prediction models, however, their additional prognostic value over patient characteristics and NCCT is limited in an unselected stroke population.

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Cerebrovascular Diseases

Tập 40 Số 5-6

258-269

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