PT - JOURNAL ARTICLE AU - Z. Chen AU - F. Shi AU - X. Gong AU - R. Zhang AU - W. Zhong AU - R. Zhang AU - Y. Zhou AU - M. Lou TI - Thrombus Permeability on Dynamic CTA Predicts Good Outcome after Reperfusion Therapy AID - 10.3174/ajnr.A5785 DP - 2018 Oct 01 TA - American Journal of Neuroradiology PG - 1854--1859 VI - 39 IP - 10 4099 - http://www.ajnr.org/content/39/10/1854.short 4100 - http://www.ajnr.org/content/39/10/1854.full SO - Am. J. Neuroradiol.2018 Oct 01; 39 AB - BACKGROUND AND PURPOSE: Thrombus permeability assessed on conventional CTA is associated with neurologic outcome in patients with acute ischemic stroke. We aimed to investigate whether dynamic CTA can improve the accuracy of thrombus permeability assessment and its predictive value for outcome.MATERIALS AND METHODS: We reviewed consecutive patients with acute ischemic stroke who had occlusion of the M1 segment of the middle artery cerebral artery and underwent pretreatment perfusion CT. Thrombus permeability, determined by thrombus attenuation increase (TAI), was assessed on 26-phase dynamic CTA derived from perfusion CT. TAImax was defined as the maximum TAI among phases; TAIpeak, as TAI of peak arterial phase; TAIcon, as TAI on phase 13. Good outcome was defined as a 3-month mRS score of ≤2.RESULTS: One hundred four patients were enrolled in the final analysis. The median TAImax, TAIpeak, and TAIcon were 30.1 HU (interquartile range, 13.0–50.2 HU), 9.5 HU (interquartile range, −1.6–28.7 HU), and 6.6 HU (interquartile range, −5.1–24.4 HU), respectively. Multivariable regression analyses showed that TAImax (OR = 1.027; 95% CI, 1.007–1.048; P = .008), TAIpeak (OR = 1.029; 95% CI, 1.005–1.054; P = .020), and TAIcon (OR = 1.026; 95% CI, 1.002–1.051; P = .037) were independently associated with good outcome. The areas under the ROC curve of TAImax, TAIpeak, and TAIcon in predicting good outcome were 0.734, 0.701, and 0.658, respectively.CONCLUSIONS: Thrombus permeability assessed on dynamic CTA could be a better predictor of outcome after reperfusion therapy than that assessed on conventional single-phase CTA.AISacute ischemic strokeAUCarea under the curveIQRinterquartile rangePHparenchymal hemorrhageONTonset to intravenous thrombolysisROCreceiver operating characteristicTAIthrombus attenuation increaseTAIconTAI on phase 13TAImaxthe maximum TAI among phasesTAIpeakTAI of peak arterial phase