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Preliminary application of CT perfusion source images for evaluating regional collateral circulation in unilateral Moyamoya disease

  
@article{QIMS25260,
	author = {Jing Xue and Yujing Peng and Yanan Zhang and Weiqi Chen and Yuesong Pan and Yu Qi and Lina Hao and Weibin Gu and Ning Wang and Peiyi Gao},
	title = {Preliminary application of CT perfusion source images for evaluating regional collateral circulation in unilateral Moyamoya disease},
	journal = {Quantitative Imaging in Medicine and Surgery},
	volume = {9},
	number = {4},
	year = {2019},
	keywords = {},
	abstract = {Background: Collateral flow is associated with clinical outcomes for patients with Moyamoya disease and served as a parameter for patient selection of therapeutic strategies. Therefore, we explored whether a noninvasive imaging modality, computed tomography perfusion (CTP) source images (CTP-Sis), could be used to identify the presence and intensity of collateral flow using digital subtraction angiography (DSA) as a gold standard for collateral flow.
Methods: CTP-Sis and DSA were performed for 24 patients with unilateral Moyamoya disease. A collateral grading system was developed based on arterial and venous phase CTP-Sis, imitating the DSA score system. Two neuroradiologists scored the DSA images using a collateral grading scale for the regions of interest corresponding to the Alberta Stroke Program Early computed tomography Score (ASPECTS) methodology. Another two neuroradiologists scored CTP-Sis in a similar manner. Agreement between the CTP-Sis and DSA consensus scores was determined, including kappa statistics. 
Results: The agreement between the CTP-Sis and DSA consensus readings was moderate to strong, with a weighted kappa value of 0.768 [95% confidence interval (CI), 0.703–0.832], but there was a better agreement for readers of CTP-Sis, as compared with those of DSA. The sensitivity and specificity for identifying collaterals with CTP-Sis were 0.714 (95% CI, 0.578–0.851) and 0.995 (95% CI, 0.985–1.000), respectively. 
Conclusions: CTP-Sis could help identify in a noninvasive manner the presence and intensity of collateral flow in patients with unilateral Moyamoya disease using DSA as a gold standard. Further study with a large number of cases is warranted. Further application of this method to other cerebrovascular diseases including acute ischemic stroke can also be warranted.},
	url = {http://qims.amegroups.com/article/view/25260}
}