Assessment of leptomeningeal collateral status using single-phase computed tomography angiography and its clinical value

At present, there is a lack of consensus regarding the high-cost performance method for evaluating the leptomeningeal collateral (LMC) status, and there are only few reports on the relationship between the LMC status and short-term neurological improvements in patients with acute middle cerebral artery (MCA) stroke. To evaluate the LMC status using single-phase computed tomography angiography (CTA) and assess the effect of the LMC status on short-term outcomes in patients with acute MCA regional ischemic stroke without reperfusion therapy. Thirty patients with acute MCA regional ischemic stroke without reperfusion therapy were sampled prospectively. Then, 256-layer single-phase CTA (using enhanced computed tomography, maximal intensity projection technology and multi-plane volume reconstruction) was used to measure each patient’s LMC status using the MCA regional collateral score. The correlation between the LMC status and changes in the National Institutes of Health Stroke Scale (NIHSS) score was assessed. Differences in the modified Rankin scale score at 3 months after discharge between patients with a good (MCA territory collateral score ≥2) and those with a poor (MCA territory collateral score 0–1) LMC status were assessed. The NIHSS score change between admission and discharge correlated with the LMC status at admission (r = 0.88, p = 0.03). Three months after discharge, the mean modified Rankin scale scores in the poor and good LMC status groups were 1.91 ± 1.65 and 1.03 ± 1.36, respectively (p = 0.0394). The NIHSS scores at 3 months after discharge in the poor and good LMC status groups were 4.31 ± 4.29 and 2.16 ± 2.06, respectively (p = 0.0489). Our findings can further reinforce the understanding of the appropriate assessment of LMCs and its clinical value. A 256-slice single-phase CTA-maximal intensity projection can provide good assessment of the LMC status. In patients with MCA regional acute ischemic stroke, the LMC status may predict the short-term prognosis. Further research is needed to confirm these findings.

Middle cerebral artery; Leptomeningeal collateral status; Modified Rankin scale score; Computed tomography angiography; Ischemic stroke

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