title: Thrombus length discrepancy on dual-phase CT can predict clinical outcome in acute ischemic stroke.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  • 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.
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Mina
authors.initials: M
authors.lastname: Park
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung-Eun
authors.initials: KE
authors.lastname: Kim
authors.affiliation: Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea. nyshin@ewha.ac.kr.
authors.forename: Na-Young
authors.initials: NY
authors.lastname: Shin
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seung-Koo
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Soo Mee
authors.initials: SM
authors.lastname: Lim
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dongbeom
authors.initials: D
authors.lastname: Song
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ji Hoe
authors.initials: JH
authors.lastname: Heo
authors.affiliation: Department of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Gyeonggi-Do, Korea.
authors.forename: Jin Woo
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Chungnam, Korea.
authors.forename: Se Won
authors.initials: SW
authors.lastname: Oh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging; D002533:Cerebral Angiography / Q000379:methods; D000072226:Computed Tomography Angiography; D003287:Contrast Media; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020767:Intracranial Thrombosis / Q000000981:diagnostic imaging*; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D020521:Stroke / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media
keywords: Brain Infarction; Middle cerebral artery; Neuroimaging; Stroke; Tomography, X-Ray computed