Abstract WP147: Multimodal CT: Favorable Outcome Factors In Acute Middle Cerebral Artery Stroke With Large Artery Occlusion
Background In acute stroke patients with large artery occlusion, we investigated the usefulness of multimodal CT as an initial predictor for a favorable outcome in addition to clinical findings. We studied which parameters of multimodal CT might be the most reliable predictors for favorable outcomes, and combination of these multimodal CT parameters to increase predictive validity, compared to a single parameter.
Methods The parameters of multimodal CT, including non-enhanced CT (NECT), CT angiography, perfusion CT parameters, CT angiography source image (CTA-SI), and collateral flow, were analyzed in 66 consecutive patients with acute middle cerebral artery stroke with large artery occlusion. To evaluate the predictive validity of individual parameters for favorable outcome at 3 month follow-up (modified Rankin scale≤ 2), receiver operating characteristic (ROC) curves were generated, and optimum predictive cutoff- Alberta Stroke Program Early CT Score (ASPECTS) was calculated. ROC curves of the individual parameters and their combinations were analyzed by pairwise comparison. As an additional imaging predictor to clinical findings for favorable outcome, crude or adjusted odds ratios of individual parameters, predefined by the optimum predictive cutoff-ASPECTS, were assessed through univariate or multivariate analyses.
Results Optimum predictive cutoffs for favorable outcome as follows: CTA-SI ASPECTS ≥ 7, cerebral blood volume (CBV) ASPECTS ≥ 6, NECT ASPECTS ≥ 10, good collateral flow, and cerebral blood flow ASPECTS ≥ 2. On the multivariate analyses, CTA-SI ASPECTS ≥ 7, CBV ASPECTS ≥ 6, and good collateral flow were associated with a favorable outcome. On the ROC analyses by pairwise comparison, the combination of those parameters had better predictive validity compared to a single parameter only: CBV (p = 0.039), CTA-SI (p = 0.038), and collateral flow (p < 0.001).
Conclusion Among the various parameters of multimodal CT, CTA-SI ASPECTS ≥ 7, CBV ASPECTS ≥ 6, and good collateral flow might be the most reliable predictors for favorable outcomes in acute stroke patients with large artery occlusion. Moreover, considering these parameters simultaneously might improve the predictive validity of multimodal CT for functional outcome.
- © 2012 by American Heart Association, Inc.