Comparing The Value Of Multiphase CT Angiography And CT Perfusion In Prognosis Prediction In Patients With Acute Ischemic Stroke

Objective The objective of this study was to compare the Menon collateral score systems assessed on single-and multiphase CT angiography and quantitative CT perfusion parameters in order to study the correlation between multiphase Menon collateral score and final infarct volume and the value in predicting clinical outcome.Methods Consecutive patients from October 2017 to August 2018 who were diagnosed as AIS caused by isolated anterior circulation artery occlusion and admitted in emergency department of Zhongda Hospital,Southeast University were retrospectively reviewed.The collateral score was assessed on s CTA and m CTA reconstructed from CTP data using established scoring systems.The correlations between baseline radiological features and final infarct volume were studied.Receiver operating characteristic curves were applied to assess the prognostic value of collateral scores and CTP parameters for a favorable 90-day clinical outcome.Logistic regressions combining the radiological and clinical parameters were performed to determine the independent predictor for a good outcome and predictive model was established.Result One hundred nineteen eligible patients(74 males,median age 75 years)with a median baseline National Institute of Health Stroke Scale(NIHSS)score of 15 were included in the study.Both the sp and the mp Menon scores had moderate negative correlations with FIV(r =-0.46,P < 0.001;r =-0.42,P < 0.001)and 90-day m RS scores(r =-0.27,P = 0.003;r =-0.43,P < 0.001).However,both the ischemic core volume and hypoperfusion volume had moderated positive correlations with FIV(r = 0.52,P < 0.001;r = 0.46,P < 0.001)and 90-day m RS score(r = 0.48,P < 0.001;r = 0.47,P < 0.001).In terms of correlation with FIV,there was no statistical difference between the mp Menon score and the quantitative CTP parameters(P = 0.33;P = 0.71).The ROC curve analysis revealed that the mp Menon score had a stronger predictive value than sp Menon score in predicting a favorable 90-day clinical outcome([AUC] 0.728 vs.0.656,P = 0.034),which was similar to the ischemic core volume([AUC] 0.728 vs.0.726,P = 0.971)and hypoperfusion volume on CTP([AUC] 0.728 vs.0.756,P = 0.617).Multivariate Logistic regression model with an AUC of 0.875(P < 0.001),which combined radiological and clinical parameters,showed that baseline NIHSS and mp Menon score were independent predictors for good clinical outcomes.Conclusion Multiphase Menon score assessed on m CTA has a moderate correlation with FIV,and is an independent predictor for favorable 90-day clinical outcome.Multiphase Menon score has stronger predictive value than single-phase Menon score,which is comparable with CTP parameters.In consideration of image acquisition,assessment and radiation dose,we consider that m CTA should be routinely used in baseline collateral assessment in patients with AIS caused by anterior circulation artery occlusion,potentially obviating CTP in outcome prediction.