Dual-phase CT collateral score: a predictor of clinical outcome in patients with acute ischemic stroke

PLoS One. 2014 Sep 11;9(9):e107379. doi: 10.1371/journal.pone.0107379. eCollection 2014.

Abstract

Background and purpose: The presence of good collaterals on CT angiography (CTA) is a well-known predictor for favorable outcome in acute ischemic stroke. Recently, multiphase CT has been introduced as a more accurate method in assessing collaterals. The aim of this study was to assess the ability of dual-phase CT to evaluate collateral status and predict clinical outcome.

Methods: Forty-three patients who underwent both dual-phase CT and transfemoral cerebral angiography (TFCA) for occluded intracranial internal carotid artery (ICA) and/or middle cerebral artery (M1 segment) were recruited from a prospectively collected database. The collateral status on dual-phase CT was graded by using a 4-point scale: grade 0 = no collaterals; 1 = some collaterals with persistence of some defects; 2 = slow but complete collaterals; and 3 = fast and complete collaterals. Univariate and multivariate analysis were performed to define the independent predictors for favorable outcome at 3 months.

Results: Dual-phase CT collateral status (ρ = 0.744) showed higher correlation with TFCA collateral status than CTA collateral status (ρ = 0.596) and substantial interobserver agreement (weighted κ = 0.776). In the univariate analysis, age, history of hypertension, collateral scores on CTA, dual-phase CT, and TFCA, occlusion in intracranial ICA, final infarct volume, and symptomatic hemorrhage were significantly associated with outcome. Among them, only the dual-phase CT collateral score was an independent predictor for favorable outcome (OR = 26.342 (2.788-248.864); P = 0.004) in the multivariate analysis.

Conclusions: The collateral status on dual-phase CT can be a useful predictor for clinical outcome in acute stroke patients, especially when advanced CT techniques are not available in emergent situations.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Infarction / diagnostic imaging*
  • Carotid Artery, Internal / diagnostic imaging
  • Cerebral Angiography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Middle Cerebral Artery / diagnostic imaging
  • Prognosis
  • Retrospective Studies
  • Severity of Illness Index
  • Stroke / diagnostic imaging*
  • Stroke / therapy
  • Tomography, X-Ray Computed
  • Treatment Outcome

Grant support

These authors have no support or funding to report.