title: Cortical Venous Filling on Dynamic Computed Tomographic Angiography: A Novel Predictor of Clinical Outcome in Patients With Acute Middle Cerebral Artery Stroke.
abstract: OBJECTIVE
  Venous flow in the downstream territory of an occluded artery may influence patient prognosis after ischemic stroke. Our aim was to study cortical venous filling (CVF) in a time-resolved manner with dynamic computed tomographic angiography and to assess the relationship with clinical outcome.
  
  
  METHODS
  Patients with a proximal middle cerebral artery occlusion underwent noncontrast CT and whole-brain CT perfusion/dynamic CT angiography within 9 hours after stroke-onset. We defined poor outcome as a modified Rankin Scale score of ≥3. Association between the extent and velocity of CVF and poor outcome at 3 months was analyzed with Poisson-regression. Prognostic value of optimal CVF (maximum opacification of cortical veins) in addition to age, stroke severity, treatment, Alberta Stroke Program Early CT score, cerebral blood flow, and collateral status was assessed with logistic regression and summarized with the area under the curve.
  
  
  RESULTS
  Eighty-eight patients were included, with a mean age of 67 years. By combining the extent and velocity of optimal CVF, we observed a decreased risk of poor outcome in patients with good and fast optimal CVF, risk ratio of 0.5 (95% confidence interval, 0.3-0.7). Extent and velocity of optimal CVF had additional prognostic value (area under the curve, 0.88; 95% confidence interval, 0.77-0.98; P<0.02) compared with a model without CVF information.
  
  
  CONCLUSIONS
  The combination of extent and velocity of optimal CVF, as assessed with dynamic CT angiography, is useful to identify patients with acute middle cerebral artery stroke at higher risk of poor clinical outcome at 3-month follow-up.
  
  
  BACKGROUND
  URL: http://www.trialregister.nl/trialreg and http://www.clinicaltrials.gov. Unique identifier: NTR1804 and NCT00880113, respectively.
authors.affiliation: From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.), Neurology (M.J.H.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.R.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (F.J.A.M.); Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.); and Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (C.B.L.M.M.). wijngaardido@gmail.com.
authors.forename: Ido R
authors.initials: IR
authors.lastname: van den Wijngaard
authors.affiliation: From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.), Neurology (M.J.H.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.R.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (F.J.A.M.); Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.); and Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (C.B.L.M.M.).
authors.forename: Marieke J H
authors.initials: MJ
authors.lastname: Wermer
authors.affiliation: From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.), Neurology (M.J.H.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.R.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (F.J.A.M.); Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.); and Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (C.B.L.M.M.).
authors.forename: Jelis
authors.initials: J
authors.lastname: Boiten
authors.affiliation: From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.), Neurology (M.J.H.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.R.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (F.J.A.M.); Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.); and Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (C.B.L.M.M.).
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.affiliation: From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.), Neurology (M.J.H.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.R.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (F.J.A.M.); Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.); and Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (C.B.L.M.M.).
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Holswilder
authors.affiliation: From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.), Neurology (M.J.H.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.R.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (F.J.A.M.); Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.); and Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (C.B.L.M.M.).
authors.forename: Frederick J A
authors.initials: FJ
authors.lastname: Meijer
authors.affiliation: From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.), Neurology (M.J.H.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.R.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (F.J.A.M.); Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.); and Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (C.B.L.M.M.).
authors.forename: Diederik W J
authors.initials: DW
authors.lastname: Dippel
authors.affiliation: From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.), Neurology (M.J.H.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.R.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (F.J.A.M.); Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.); and Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (C.B.L.M.M.).
authors.forename: Birgitta K
authors.initials: BK
authors.lastname: Velthuis
authors.affiliation: From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.), Neurology (M.J.H.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.R.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (F.J.A.M.); Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.); and Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (C.B.L.M.M.).
authors.forename: Charles B L M
authors.initials: CB
authors.lastname: Majoie
authors.affiliation: From the Departments of Radiology (I.R.v.d.W., G.H., M.A.A.v.W.), Neurology (M.J.H.W.), and Clinical Epidemiology (A.A.), Leiden University Medical Center, Leiden, The Netherlands; Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands (I.R.v.d.W., J.B.); Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.) and Department of Radiology (B.K.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands (F.J.A.M.); Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (D.W.J.D.); and Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands (C.B.L.M.M.).
authors.forename: Marianne A A
authors.initials: MA
authors.lastname: van Walderveen
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods*; D002550:Cerebral Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D020521:Stroke / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: angiography; brain; confidence intervals; prognosis; stroke