| Objective: To appraise the value on clinical application of MRA and CTA in assessment of cerebral collateral circulation by evaluating concordance between the two methods and DSA,respectively and explore the effect of cerebral collateral circulation on the clinical outcome of acute cerebral infarction.Methods: From January,2015 to December,2016,85 cases with unilateral ICA or MCA-M1 severe stenosis or occlusion confirmed by DSA,who attended department of neurology of Lanzhou General Hospital,Lanzhou Military Area were collected.Among them,57 underwent MRA and DSA,12 underwent CTA and DSA,5 underwent MRA?CTA and DSA and 40 cases were diagnosed with acute cerebral infarction via DWI.(1)Cohen's Kappa coefficient was used to evaluate the concordance between MRA-SI as well as CTA-SI and DSA,respectively.(2)The correlations between cerebral collateral circulation and NIHSS/mRS after three months will be analyzed by Spearman rank correlation.(3)Application of ROC curve analysis on the threshold of total collateral score about clinical prognosis.(4)We will compare the clinical outcome between good and bad total CS to verify the conclusion that the threshold of total collateral circulation is one of the indexes assessing the clinical outcome making use of Fisher exact probability test.(5)In addition,we will analyze the impact factors of cerebral collateral circulation through multivariate Logistic regression analysis.Results:(1)The agreement in assessment of cerebral collateral circulation between MRA-SI and DSA was least favorable(K=0.269,P<0.05),nor MRA-SI and CTA-SI(K=0.282,P<0.05).The agreement between CTA-SI and DSA was moderate(K=0.444,P<0.05).(2)There was a negative correlation between total CS and 3-month NIHSS(?=-0.467,P=0.003)as well as 3-month mRS(?=-0.669,P<0.001).(3)The total CS =18.5,which is the threshold predicting clinical outcome(mRS?2)has the highest combination of sensitivity(81.5%)and specificity(90.9%)?The AUC of the ROC curve is 0.924(95%CI:0.835-1.0,P<0.001).In addition,difference of the clinical prognosis between total CS?19 and total CS<19 have statistical significance(P<0.001);(4)On multiple Logistic regression analysis,no single vascular risk factors(including age?sex?diabetes?hypertension?hyperlipidemia and previous stroke)was associated with the presence of poor collateral circulation.Conclusion:(1)DSA that can't be replaced by MRA and CTA is still the reference standard in assessment of cerebral collateral circulation.If DSA is unable to be taken,CTA can been done for preliminary assessment of collateral circulation.(2)Cerebral collateral circulation has an influence on clinical prognosis of acute cerebral infarction.Good collateral circulation will have a relatively better outcome and the total CS=19 can be one of the indexes assessing the clinical outcome.(3)None of hypertension?diabetes?hyperlipidemia?women and age are the risk factors of cerebral collateral circulation. |
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