title: Collateral flow and brain changes on computed tomography angiography predict infarct volume on early diffusion-weighted imaging.
abstract: BACKGROUND
  We investigated whether a computed tomography (CT)-based score could predict a large infarct (≥ 80 mL) on early diffusion-weighted magnetic resonance imaging (DWI).
  
  
  METHODS
  Acute stroke patients considered for endovascular therapy within 8 hours of the onset of symptoms were included. The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was determined on noncontrast CT and computed tomography angiography source images (CTA-SI). Limited collateral flow was defined as less than 50% collateral filling on CTA-SI.
  
  
  RESULTS
  Fifty-six patients were analyzed. National Institutes of Health Stroke Scale score was 20 (15-24) in the large infarct group and 16 (11-20) in the small infarct group (P = .049). ASPECTS on noncontrast CT and CTA-SI was 5 (3-8) and 3 (2-6) in the large infarct group and 9 (8-10) and 8 (7-9) in the small infarct group (both P < .001), respectively. Limited collateral flow was frequent in the large infarct group than in the small infarct group (92% vs. 11%, P < .001). Multivariate analysis found that CTA-SI ASPECTS less than or equal to 5 (odds ratio [OR], 40.55; 95% confidence interval [CI], 1.10-1493.44; P = .044) and limited collateral flow (OR, 114.64; 95% CI, 1.93-6812.79; P = .023) were associated with a large infarct. Absence of ASPECTS less than or equal to 5 and limited collateral flow on CTA-SI predicted absence of a large infarct with a sensitivity of .89, specificity of 1.00, positive predictive value of 1.00, and negative predictive value of .71.
  
  
  CONCLUSIONS
  Assessment of ASPECTS and collateral flow on CTA-SI may be able to exclude a patient with large infarct on early DWI.
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: aojyun@hotmail.com.
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Tateishi
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Cummings
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Esteban
authors.initials: E
authors.lastname: Cheng-Ching
authors.affiliation: Center for Neuroimaging, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Paul
authors.initials: P
authors.lastname: Ruggieri
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Muhammad Shazam
authors.initials: MS
authors.lastname: Hussain
authors.affiliation: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ken
authors.initials: K
authors.lastname: Uchino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography / Q000379:methods*; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D055420:Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D014057:Tomography, X-Ray Computed
keywords: Acute stroke; computed tomography; computed tomography angiography; magnetic resonance imaging