Comparative Study On Different Assessment Methods Of Cerebral Collateral Circulation Based On CTA

Objective At present,there are many methods for evaluating collateral circulation based on CTA,and the clinical choice is still controversial.The following 4 CTA-based cerebral collateral assessment methods were selected: miteff score(proposed by Ferdinand Miteff et al.2009),Sylvian fissure,convexity collateral score(maas score),MCA territory collareral score(tan score)and regional leptomeningral score(r LMC)were compared with the perfusion results based on CTP,and the correlation between the evaluation of cerebral collateral circulation and the results of CT perfusion was analyzed.At the same time,the National Institutes of Health Stroke Scale(NIHSS)was used to analyze the application value of various collateral assessment methods and CTP in the treatment and prognosis prediction of patients with acute cerebral infarction.Materials and methods A retrospective analysis was performed on patients diagnosed with ischemic cerebrovascular disease in the Affiliated Hospital of Qingdao University from June 2018 to June 2021.According to the inclusion and exclusion criteria of the study,79 cases were finally included.All patients underwent cranial CTP and CTA examination,and their clinical and imaging data were collected.According to the CTP perfusion results(CBV value),the subjects were divided into 3 groups: fully compensated group,moderately compensated group,and insufficiently compensated group;the subjects were divided into infarction group and non-infarction group according to imaging and clinical manifestations.Spearman’s correlation coefficient(Spearman)was used to evaluate the correlation between CTA-based collateral compensation score and CTP-based perfusion results in all cases,infarcted,and non-infarcted groups;NIHSS score and CTA-based collateral in infarction group were evaluated Correlation between compensation score,CTP-based perfusion outcome.Results(1)From 2018 to 2021,136 patients who met the criteria were included,44 patients whose PCT-SI data could not be obtained due to data storage problems were excluded,and 13 patients whose imaging examination showed that the responsible vessel was bilateral,The final sample included 79 patients,divided into 55 patients in the cerebral infarction group and 24 patients in the non-infarction group,of which the non-infarction group was mainly patients with transient cerebral ischemia(TIA).The average age was 61 years old,of whom 33 were women,accounting for 42%.The MCA had the highest number of occlusions or severe stenosis(M1 segment,65%).There were55 cases in the cerebral infarction group,and the median NIHSS score at admission was 4points(IQR2-6 points).Three underwent balloon angioplasty and five underwent stenting.There were 52 cases with good prognosis(m RS ≤ 2),and only 3 cases with poor prognosis(m RS ≥ 3),of which 1 died.(2)The demographic data of patients in the infarction group and the non-infarction group and the baseline data of each group showed that the comparison between the infarction group and the non-infarction group of each related factor group showed that hypertension,age,gender,diabetes,dyslipidemia and other factors were significantly different between the groups.No statistically significant difference.CTP-based perfusion results(sufficiently compensated group,moderately compensated group,and insufficiently compensated group)patient demographics and baseline data of each group showed differences in age,gender,hypertension,diabetes,and dyslipidemia among groups with different levels of compensation Not statistically significant.(3)The perfusion results based on CTP in all cases(adequate compensation group,moderate group and insufficient group)were moderately correlated with miteff score,maas score,tan score,and r LMC score(r=0.579,r=0.497,r=0.697,r=0.757;both P<0.01).Among them,the CTP-based perfusion results in the infarction group were moderately to strongly correlated with each collateral score: the infarction group was moderately correlated with the miteff score(r=0.717,P<0.01);moderately correlated with the maas score Correlation(r=0.567,P < 0.01);moderately correlated with tan score(r=0.640,P<0.01);strongly correlated with r LMC score(r=0.845,P<0.01).CTP-based perfusion results in the non-infarct group were weakly correlated with tan score(r=0.408;P<0.05),moderately correlated with r LMC score(r=0.520,P<0.05),and correlated with miteff score,maas scores were not correlated.(4)The NIHSS score was moderately negatively correlated with the CTP-based perfusion results,miteff score,and r LMC score in the cerebral infarction group(r=-0.680,r=-0.524,r=-0.618;all P<0.01),and There was a weak negative correlation between maas score and tan score(r=-0.392,r=-0.452;P<0.01).Conclusion 1.The CTA collateral score was positively correlated with the CTP perfusion results(CBV value)in patients with ischemic cerebrovascular disease.Among the patients with acute cerebral infarction,the r LMC score had the strongest correlation with CTP perfusion results,and the maas score had the worst correlation.2.The CTA collateral compensation score was negatively correlated with the NIHSS score,and the correlation between the CTP perfusion results and the NIHSS score was stronger,followed by the r LMC score.3.CTA collateral score,especially r LMC score,can be used as an effective tool to evaluate collateral circulation in patients with acute cerebral infarction,combined with NIHSS score can be used to evaluate prognosis,which is helpful for clinical decision-making.