Multimodal CT: favorable outcome factors in acute middle cerebral artery stroke with large artery occlusion

Background: We investigated which parameters of multimodal computed tomography (CT) or their combinations might be useful as additional imaging predictors for favorable outcomes in acute stroke patients with large artery occlusion.

Methods: The parameters of multimodal CT, including non-enhanced CT, CT angiography, perfusion CT parameters, CT angiography source image (CTA-SI), and collateral flow, were analyzed in 66 consecutive patients with acute middle cerebral artery stroke with large artery occlusion. For favorable outcomes at the 3-month follow-up, odds ratios of multimodal CT parameters with an optimum predictive cut-off Alberta Stroke Program Early CT Score (ASPECTS) were assessed.

Results: Cerebral blood volume (CBV) ASPECTS ≥6, CTA-SI ASPECTS ≥7, and good collateral flow were associated with a favorable outcome. The combination of those parameters had better predictive validity compared to a single parameter only: CBV (p = 0.039), CTA-SI (p = 0.038), and collateral flow (p < 0.001).

Conclusion: Among the various parameters of multimodal CT, CBV ASPECTS ≥6, CTA-SI ASPECTS ≥7, and good collateral flow might be the most reliable predictors for favorable outcomes in acute stroke patients with large artery occlusion. Moreover, considering these parameters simultaneously might improve the predictive validity of multimodal CT for functional outcome.