Thrombus length discrepancy on dual-phase CT can predict clinical outcome in acute ischemic stroke

Mina Park, Kyung eun Kim, Na Young Shin, Seung Koo Lee, Soo Mee Lim, Dongbeom Song, Ji Hoe Heo, Jin Woo Kim, Se Won Oh

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: The thrombus length may be overestimated on early arterial computed tomography angiography (CTA) depending on the collateral status. We evaluated the value of a grading system based on the thrombus length discrepancy on dual-phase CT in outcome prediction. Methods: Forty-eight acute ischemic stroke patients with M1 occlusion were included. Dual-phase CT protocol encompassed non-contrast enhanced CT, CTA with a bolus tracking technique, and delayed contrast enhanced CT (CECT) performed 40s after contrast injection. The thrombus length discrepancy between CTA and CECT was graded by using a three-point scale: G0 = no difference; G1 = no difference in thrombus length, but in attenuation distal to thrombus; G2 = difference in thrombus length. Univariate and multivariate analyses were performed to define independent predictors of poor clinical outcome at 3 months. Results: The thrombus discrepancy grade showed significant linear relationships with both the collateral status (P = 0.008) and the presence of antegrade flow on DSA (P = 0.010) with good interobserver agreement (κ = 0.868). In a multivariate model, the presence of thrombus length discrepancy (G2) was an independent predictor of poor clinical outcome [odds ratio = 11.474 (1.350–97.547); P =0.025]. Conclusions: The presence of thrombus length discrepancy on dual-phase CT may be a useful predictor of unfavourable clinical outcome in acute M1 occlusion patients. Key points: • Early arterial phase CTA may underestimate thrombus length. • Thrombus length discrepancy grade reflects collateral status or presence of antegrade flow. • Outcome prediction may be better with thrombus length grade than collateral score.

Original languageEnglish
Pages (from-to)2215-2222
Number of pages8
JournalEuropean Radiology
Volume26
Issue number7
DOIs
Publication statusPublished - 2016 Jul 1

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Thrombosis
Stroke
Multivariate Analysis
Odds Ratio
Injections
Computed Tomography Angiography

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

Park, M., Kim, K. E., Shin, N. Y., Lee, S. K., Lim, S. M., Song, D., ... Oh, S. W. (2016). Thrombus length discrepancy on dual-phase CT can predict clinical outcome in acute ischemic stroke. European Radiology, 26(7), 2215-2222. https://doi.org/10.1007/s00330-015-4018-3
Park, Mina ; Kim, Kyung eun ; Shin, Na Young ; Lee, Seung Koo ; Lim, Soo Mee ; Song, Dongbeom ; Heo, Ji Hoe ; Kim, Jin Woo ; Oh, Se Won. / Thrombus length discrepancy on dual-phase CT can predict clinical outcome in acute ischemic stroke. In: European Radiology. 2016 ; Vol. 26, No. 7. pp. 2215-2222.
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abstract = "Objectives: The thrombus length may be overestimated on early arterial computed tomography angiography (CTA) depending on the collateral status. We evaluated the value of a grading system based on the thrombus length discrepancy on dual-phase CT in outcome prediction. Methods: Forty-eight acute ischemic stroke patients with M1 occlusion were included. Dual-phase CT protocol encompassed non-contrast enhanced CT, CTA with a bolus tracking technique, and delayed contrast enhanced CT (CECT) performed 40s after contrast injection. The thrombus length discrepancy between CTA and CECT was graded by using a three-point scale: G0 = no difference; G1 = no difference in thrombus length, but in attenuation distal to thrombus; G2 = difference in thrombus length. Univariate and multivariate analyses were performed to define independent predictors of poor clinical outcome at 3 months. Results: The thrombus discrepancy grade showed significant linear relationships with both the collateral status (P = 0.008) and the presence of antegrade flow on DSA (P = 0.010) with good interobserver agreement (κ = 0.868). In a multivariate model, the presence of thrombus length discrepancy (G2) was an independent predictor of poor clinical outcome [odds ratio = 11.474 (1.350–97.547); P =0.025]. Conclusions: The presence of thrombus length discrepancy on dual-phase CT may be a useful predictor of unfavourable clinical outcome in acute M1 occlusion patients. Key points: • Early arterial phase CTA may underestimate thrombus length. • Thrombus length discrepancy grade reflects collateral status or presence of antegrade flow. • Outcome prediction may be better with thrombus length grade than collateral score.",
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Park, M, Kim, KE, Shin, NY, Lee, SK, Lim, SM, Song, D, Heo, JH, Kim, JW & Oh, SW 2016, 'Thrombus length discrepancy on dual-phase CT can predict clinical outcome in acute ischemic stroke', European Radiology, vol. 26, no. 7, pp. 2215-2222. https://doi.org/10.1007/s00330-015-4018-3

Thrombus length discrepancy on dual-phase CT can predict clinical outcome in acute ischemic stroke. / Park, Mina; Kim, Kyung eun; Shin, Na Young; Lee, Seung Koo; Lim, Soo Mee; Song, Dongbeom; Heo, Ji Hoe; Kim, Jin Woo; Oh, Se Won.

In: European Radiology, Vol. 26, No. 7, 01.07.2016, p. 2215-2222.

Research output: Contribution to journalArticle

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T1 - Thrombus length discrepancy on dual-phase CT can predict clinical outcome in acute ischemic stroke

AU - Park, Mina

AU - Kim, Kyung eun

AU - Shin, Na Young

AU - Lee, Seung Koo

AU - Lim, Soo Mee

AU - Song, Dongbeom

AU - Heo, Ji Hoe

AU - Kim, Jin Woo

AU - Oh, Se Won

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N2 - Objectives: The thrombus length may be overestimated on early arterial computed tomography angiography (CTA) depending on the collateral status. We evaluated the value of a grading system based on the thrombus length discrepancy on dual-phase CT in outcome prediction. Methods: Forty-eight acute ischemic stroke patients with M1 occlusion were included. Dual-phase CT protocol encompassed non-contrast enhanced CT, CTA with a bolus tracking technique, and delayed contrast enhanced CT (CECT) performed 40s after contrast injection. The thrombus length discrepancy between CTA and CECT was graded by using a three-point scale: G0 = no difference; G1 = no difference in thrombus length, but in attenuation distal to thrombus; G2 = difference in thrombus length. Univariate and multivariate analyses were performed to define independent predictors of poor clinical outcome at 3 months. Results: The thrombus discrepancy grade showed significant linear relationships with both the collateral status (P = 0.008) and the presence of antegrade flow on DSA (P = 0.010) with good interobserver agreement (κ = 0.868). In a multivariate model, the presence of thrombus length discrepancy (G2) was an independent predictor of poor clinical outcome [odds ratio = 11.474 (1.350–97.547); P =0.025]. Conclusions: The presence of thrombus length discrepancy on dual-phase CT may be a useful predictor of unfavourable clinical outcome in acute M1 occlusion patients. Key points: • Early arterial phase CTA may underestimate thrombus length. • Thrombus length discrepancy grade reflects collateral status or presence of antegrade flow. • Outcome prediction may be better with thrombus length grade than collateral score.

AB - Objectives: The thrombus length may be overestimated on early arterial computed tomography angiography (CTA) depending on the collateral status. We evaluated the value of a grading system based on the thrombus length discrepancy on dual-phase CT in outcome prediction. Methods: Forty-eight acute ischemic stroke patients with M1 occlusion were included. Dual-phase CT protocol encompassed non-contrast enhanced CT, CTA with a bolus tracking technique, and delayed contrast enhanced CT (CECT) performed 40s after contrast injection. The thrombus length discrepancy between CTA and CECT was graded by using a three-point scale: G0 = no difference; G1 = no difference in thrombus length, but in attenuation distal to thrombus; G2 = difference in thrombus length. Univariate and multivariate analyses were performed to define independent predictors of poor clinical outcome at 3 months. Results: The thrombus discrepancy grade showed significant linear relationships with both the collateral status (P = 0.008) and the presence of antegrade flow on DSA (P = 0.010) with good interobserver agreement (κ = 0.868). In a multivariate model, the presence of thrombus length discrepancy (G2) was an independent predictor of poor clinical outcome [odds ratio = 11.474 (1.350–97.547); P =0.025]. Conclusions: The presence of thrombus length discrepancy on dual-phase CT may be a useful predictor of unfavourable clinical outcome in acute M1 occlusion patients. Key points: • Early arterial phase CTA may underestimate thrombus length. • Thrombus length discrepancy grade reflects collateral status or presence of antegrade flow. • Outcome prediction may be better with thrombus length grade than collateral score.

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