Comparison of collateral circulation scales by computed tomographic angiography

Abstract

Objective To compare the regional leptomeningeal (rLMC) scale scores, Miteff scale scores and Tan scale scores to provide the clinical basis for selecting collateral circulation evaluation methods. Methods One hundred and fifteen patients with acute ischemic stroke, admitted to our hospital from August 2013 to February 2017 were chosen in our study. The rLMC scale, Miteff scale, and Tan scale were used to evaluate the collateral circulations of each patient. The credibility and validity of these 3 scales were compared. Modified Rankin scale (mRS) scores at 3 months were followed by 0-2 for good prognosis and 3-6 for poor prognosis. Binary Logistic regression analysis was used to determine the independent prognostic factors of ischemic stroke. Receiver operating characteristic (ROC) curve was used to compare the predictive values of the 3 scales for prognoses of ischemic stroke. Results Intra-observer agreement of the 3 scales from the highest to the lowest was rLMC scale (Kappa=0.871), Tan scale (Kappa=0.842), and Miteff scale (Kappa=0.752). The test-retest reliability of the 3 scales from the highest to the lowest was rLMC scale (Kappa=0.879), Tan scale (Kappa=0.826), and Miteff scale (Kappa=0.775). The validity of the 3 scales from the highest to the lowest was rLMC scale (rs=0.690), Tan scale (rs= 0.680), and Miteff scale (rs=0.650). Univariable and multivariable analyses showed that the results of collateral circulation defined by rLMC scale (OR=1.325, 95%CI=1.048-1.675, P=0.019), Tan scale (OR=2.938, 95%CI=1.115-7.744, P=0.029) and Miteff scale (OR=2.698, 95%CI=1.050-6.931, P=0.039) were associated with prognoses of acute ischemic stroke. ROC curve showed that the area under the curve of rLMC scale, Tan scale, and Miteff scale was 0.848, 0.799, and 0.759, respectively; there were significant differences among the 3 scoring methods in the area under the curve (P Tan scale>Miteff scale. Conclusions As compared with Miteff scale and Tan scale, rLMC scale has high intra-observer agreement and validity, and is reliable but complicated. The results of collateral circulation defined by these 3 scoring methods are associated with the prognoses of acute ischemic stroke. Key words: Ischemic stroke; CTA; Collateral circulation; Prognosis