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AJNR - American Journal of Neuroradiology

Published ahead of print on January 15, 2009
doi: 10.3174/ajnr.A1408

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American Journal of Neuroradiology 30:525-531, March 2009
© 2009 American Society of Neuroradiology

BRAIN

CT Angiography Clot Burden Score and Collateral Score: Correlation with Clinical and Radiologic Outcomes in Acute Middle Cerebral Artery Infarct

I.Y.L. Tan^a, A.M. Demchuk^d, J. Hopyan^b, L. Zhang^c, D. Gladstone^b, K. Wong^a, M. Martin^a, S.P. Symons^a, A.J. Fox^a and R.I. Aviv^a

^a Departments of Neuroradiology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
^b Neurology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
^c Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
^d Department of Clinical Neurosciences, University of Calgary, Calgary Stroke Program, Calgary, Alberta, Canada

Please address correspondence to Richard Aviv, MD, Department of Medical Imaging, Division of Neuroradiology, Rm AG31, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada; e-mail: Richard.Aviv{at}sunnybrook.ca

BACKGROUND AND PURPOSE: Clot extent, location, and collateral integrity are important determinants of outcome in acute stroke. We hypothesized that a novel clot burden score (CBS) and collateral score (CS) are important determinants of clinical and radiologic outcomes and serve as useful additional stroke outcome predictors.

MATERIALS AND METHODS: One hundred twenty-one patients with anterior circulation infarct presenting within 3 hours of stroke onset were reviewed. The Spearman correlation was performed to assess the correlation between CBS and CS and clinical and radiologic outcome measures. Patients were dichotomized by using a 90-day modified Rankin scale (mRS) score. Uni- and multivariate logistic regression models were used to assess variables predicting favorable clinical and radiologic outcomes. Receiver operating characteristic and intraclass correlation coefficient (ICC) analyses were performed. Diagnostic performance of a CBS threshold of >6 was assessed.

RESULTS: There were 85 patients (mean age, 70 ± 14.5 years). Patients with higher CBS and CS demonstrated smaller pretreatment perfusion defects and final infarct volume and better clinical outcome (all, P < .01). CBS (P = .009) and recanalization (P = .015) independently predicted favorable outcome. A CBS >6 predicted good clinical outcome with an area under the curve of 0.75 (95% confidence interval [CI], 0.65–0.84; P = .0001), sensitivity of 73.0 (95% CI, 55.9–86.2), and specificity of 64.6 (95% CI, 49.5–77.8). The recanalization rate with intravenous recombinant tissue plasminogen activator was higher in patients with CBS >6 (P = .04; odds ratio, 3.2; 95% CI, 1.1–9.4). The ICC was 0.97 (95% CI, 0.95–0.98) and 0.87 (95% CI, 0.80–0.91) for CBS and CS, respectively.

CONCLUSIONS: CBS and CS are useful additional markers predicting clinical and radiologic outcomes.

This article has been cited by other articles:

				A. J. Fox, S. P. Symons, R. I. Aviv, P. Howard, R. Yeung, and E. S. Bartlett Should Modeling Methodology Suppress Anatomic Excellence? Stroke, November 1, 2009; 40(11): 3411 - 3412. [Full Text] [PDF]