Imaging features of cardioembolic stroke on 4-dimensional computed tomography angiography

作者全名："Wu, Jiajing; Liu, Jiayang; Wang, Jingjie; Li, Jing; Gu, Sirun; Yao, Yunzhuo; Xiong, Hua; Li, Yongmei"

作者地址："[Wu, Jiajing; Liu, Jiayang; Wang, Jingjie; Li, Jing; Gu, Sirun; Yao, Yunzhuo; Li, Yongmei] Chongqing Med Univ, Affiliated Hosp 1, Dept Radiol, 1 Youyi Rd, Chongqing 400016, Peoples R China; [Wu, Jiajing] 958th Hosp Peoples Liberat Army, Dept Radiol, Chongqing, Peoples R China; [Xiong, Hua] Univ Chinese Acad Sci, Chongqing Gen Hosp, Dept Radiol, Chongqing, Peoples R China"

通信作者："Wang, JJ; Li, YM (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Radiol, 1 Youyi Rd, Chongqing 400016, Peoples R China."

来源：QUANTITATIVE IMAGING IN MEDICINE AND SURGERY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001040437600001

JCR分区：Q2

影响因子：2.9

年份：2023

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Article; Early Access

关键词：Stroke etiology; cardioembolic stroke; clot length; clot burden score (CBS); time maximum intensity projection (MIP)

摘要："Background: Identifying cardioembolic stroke is important for the decision-making of endovascular treatment and anticoagulation therapy. We aimed to explore the features of cardioembolic stroke on 4-dimensional (4D) computed tomography angiography (4D-CTA) and assess whether these features can assist in classifying stroke etiology. Methods: In this retrospective study, we analyzed the images of 294 patients with acute ischemic stroke (AIS) from July 2020 to February 2022 at the First Affiliated Hospital of Chongqing Medical University, which had been consecutively collected. The data of 110 patients with occlusion of the M1/M2 segment of the middle cerebral artery (MCA) with/without intracranial internal carotid artery (ICA) occlusion were analyzed to calculate the clot burden score (CBS) and collateral score (CS), and the data of 88 patients with a clear origin and distal part were analyzed to measure clot length. Maximum intensity projection (MIP) and time MIP (tMIP) post-processing were used to assess the clot features. The Mann-Whitney U test was used to compare the clot characteristics between the 2 groups. Binary logistic regression was performed to assess the association between the image characteristics and cardioembolic stroke. Moreover, the receiver operating characteristic (ROC) curve was used to test the diagnostic efficacy of MIP/tMIP clot features in classifying cardioembolic stroke. Results: Age, high-risk factors for cerebrovascular disease, high/medium-risk sources of cardioembolic stroke, clot length, CBS, and CS were significantly different between the cardioembolic stroke group and non-cardioembolic stroke group (P<0.05). In the cardioembolic stroke group, the median MIP and tMIP clot length was 12 mm [interquartile range (IQR), 8.3-17.4 mm] and 9.3 mm (IQR, 6.8-14.3 mm), respectively. In the non-cardioembolic stroke group, the median MIP and tMIP clot length was 6.5 mm (IQR, 4.7-11.5 mm) and 5.8 mm (IQR, 3.9-10.6 mm), respectively. Binary logistic regression showed that cardioembolic stroke was significantly associated with MIP-clot length [odds ratio (OR), 1.15; 95% confidence interval (CI): 1.02- 1.29; P<0.05], tMIP-clot length (OR, 1.18; 95% CI: 1.02-1.36; P<0.05), and tMIP-CBS (OR, 3.96; 95% CI: 1.08-14.58; P<0.05). The area under the ROC curve (AUC) values of MIP clot length for identifying cardioembolic stroke were 0.75 (95% CI: 0.65-0.84, P<0.05), with a cut-off value of >7.4 mm [sensitivity: 84.62% (95% CI: 69.50-94.10%); specificity: 59.18% (95% CI: 44.20-73.00%)]. The AUC value of tMIP clot length was 0.72 (95% CI: 0.61-0.81, P<0.05), with a cut-off value of >5.4 mm [sensitivity: 92.31% (95% CI: 79.10-98.40%); specificity: 48.98% (95% CI: 34.40-63.70%)]. Conclusions: Clot length and CBS were overestimated on MIP images. Among the clot characteristics, clot length could identify cardioembolic stroke."

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