- Design
- Multicentre retrospective method validation
- Population
- 242 patients with anterior circulation large-vessel occlusion
- Primary outcome
- Correlation of quantitative venous attenuation with visual scores
- Effect
- Cortical veins ρ 0.72–0.77; AUC 0.81–0.95 for opacification categories
Poor cortical venous opacification on CT angiography is linked to worse outcomes after large-vessel occlusion stroke, but visual scoring is subjective and coarse. A multicentre retrospective study developed a semi-automated method that measures Hounsfield units along centrelines of predefined cortical and deep veins on routine single-phase CTA.
In 242 patients with anterior circulation occlusion (median age 75, median NIHSS 14.5), quantitative attenuation correlated strongly with visual scores for cortical veins (ρ 0.72 to 0.77) and discriminated opacification categories well (AUC 0.81 to 0.95). It also retained measurable signal in veins graded visually as non-opacified, giving continuous information that a visual scale loses. Results were consistent across centres.
The method is not yet linked to outcomes in this paper. Its value is as a reproducible biomarker that could enter trial selection and, eventually, triage, without any additional scan.
- Quantitative venous attenuation on routine CTA matched visual venous outflow scores closely for cortical veins.
- The method measured residual opacification in veins that looked empty to the eye.
- No additional acquisition is needed; it uses the standard stroke CTA.
- Until outcome data are published, continue to report venous outflow with established visual scores.
Why it matters
Venous outflow is a marker of collateral health, and making it objective could sharpen who benefits from thrombectomy.
Don't overread it
The study validated agreement with visual scores; it did not show the measure predicts outcome.
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