title: Prognostic evaluation based on cortical vein score difference in stroke.
abstract: OBJECTIVE
  Multimodal imaging in acute ischemic stroke defines the extent of arterial collaterals, resultant penumbra, and associated infarct core, yet limitations abound. We identified superficial and deep venous drainage patterns that predict outcomes in patients with a proximal arterial occlusion of the anterior circulation.
  
  
  METHODS
  An observational study that used computed tomography (CT) angiography to detail venous drainage in a consecutive series of patients with a proximal anterior circulation arterial occlusion. The principal veins that drain the cortex (superficial middle cerebral, vein of Trolard, vein of Labbé, and basal vein of Rosenthal) and deep structures were scored with a categorical scale on the basis of degree of contrast enhancement. The Prognostic Evaluation based on Cortical vein score difference In Stroke score encompassing the interhemispheric difference of the composite scores of the veins draining the cortices (superficial middle cerebral+vein of Trolard+vein of Labbé+basal vein of Rosenthal) was analyzed with respect to 90-day modified Rankin Scale outcomes.
  
  
  RESULTS
  Thirty-nine patients were included in the study. A Prognostic Evaluation based on Cortical vein score difference In Stroke score of 4 to 8 accurately predicted poor outcomes (modified Rankin Scale, 3-6; odds ratio, 20.53; P<0.001). On stepwise logistic regression analyses adjusted for CT Alberta stroke program early CT score, CT angiography collateral grading and National Institutes of Health Stroke Scale score, a Prognostic Evaluation based on Cortical vein score difference In Stroke score of 4 to 8 (odds ratio, 23.598; P=0.009) and an elevated admission National Institutes of Health Stroke Scale (odds ratio, 1.423; P=0.023) were independent predictors of poor outcome.
  
  
  CONCLUSIONS
  The Prognostic Evaluation based on Cortical vein score difference In Stroke score, a novel measure of venous enhancement on CT angiography, accurately predicts clinical outcomes. Venous features on computed tomography angiography provide additional characterization of collateral perfusion and prognostication in acute ischemic stroke.
authors.affiliation: From the Departments of Medicine (R.P., M.K., T.J., K.S.B., A.S.) and Radiology and Diagnostic Imaging (J.L.R.), University of Alberta, Edmonton, Alberta, Canada; and UCLA Stroke Center, Los Angeles, CA (D.S.L.).
authors.forename: Rajsrinivas
authors.initials: R
authors.lastname: Parthasarathy
authors.forename: Mahesh
authors.initials: M
authors.lastname: Kate
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Rempel
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.forename: Thomas
authors.initials: T
authors.lastname: Jeerakathil
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Butcher
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002550:Cerebral Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020521:Stroke / Q000000981:diagnostic imaging / Q000503:physiopathology; D014057:Tomography, X-Ray Computed
keywords: angiography; brain ischemia; cerebral veins; collateral circulation; perfusion; stroke