Automated ASPECTS in Acute Ischemic Stroke: A Comparative Analysis with CT Perfusion

Sundaram, Vandana; Goldstein, Jared; Wheelwright, Danielle; Aggarwal, A.; Pawha, Puneet; Doshi, Amish; Fifi, Johanna T; Leacy, Reade De; Mocco, J; Puig, Josep; Nael, Kambiz

doi:10.3174/ajnr.a6303

Cited by 31 publications

(41 citation statements)

References 37 publications

(48 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study showed that there was no significant difference between the NCCT- and Auto-ASPECTS, which is consistent with previous studies [ 7 – 9 , 19 , 22 – 24 ]. Sundaram et al showed that the Auto-ASPECTS performed equally and the NCCT-ASPECTS in both the early and late time windows (≥ 6 or < 6 h) [ 19 ]. This shows that the Auto-ASPECTS has great potential in accelerating the evaluation of AIS patients, which could save time and reduce the burden of the doctors and may be widely applied in stroke centers at all levels.…”

Section: Discussionsupporting

confidence: 93%

“…In this study, the scores of the CTP-ASPECTS method were significantly lower than those of the other two scoring methods. The median CTP-ASPECTS was 6, which was lower than the previously reported 8, which might be due to the relatively high proportion of ASPECTS < 6 in the present study (23/63 vs 6/58) [ 19 ]. Since CTP can provide quantitative parameters such as the volume of the infarct core and ischemic penumbra, the CTP-ASPECTS may better reflect the true status of ischemic territory than the NCCT-ASPECTS.…”

Section: Discussioncontrasting

confidence: 89%

“…CTP provides a more sensitive evaluation of EICs in AIS patients owing to it contains both physiologic and hemodynamic information about the ischemic tissue [ 19 ]. It offers several quantitative hemodynamic parameters, such as rCBV, rCBF and Tmax, which can reflect the perfusion status of ischemic brain tissue in AIS patients.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

CT perfusion based ASPECTS improves the diagnostic performance of early ischemic changes in large vessel occlusion

et al. 2021

View full text Add to dashboard Cite

Background ASPECTS scoring method varies, but which one is most suitable for predicting the prognosis still unclear. We aimed to evaluate the diagnostic performance of Automated (Auto)-, noncontrast CT (NCCT)- and CT perfusion (CTP) -ASPECTS for early ischemic changes (EICs) in acute ischemic stroke patients with large vessel occlusion (LVO) and to explore which scoring method is most suitable for predicting the clinical outcome. Methods Eighty-one patients with anterior circulation LVO were retrospectively enrolled and grouped as having a good (0–2) or poor (3–6) clinical outcome using a 90-day modified Rankin Scale score. Clinical characteristics and perfusion parameters were compared between the patients with good and poor outcomes. Differences in scores obtained with the three scoring methods were assessed. Diagnosis performance and receiver operating characteristic (ROC) curves were used to evaluate the value of the three ordinal or dichotomized ASPECTS methods for predicting the clinical outcome. Results Sixty-three patients were finally included, with 36 (57.1%) patients having good clinical outcome. Significant differences were observed in the ordinal or dichotomized Auto-, NCCT- and CTP-ASPECTS between the patients with good and poor clinical outcomes (all p < 0.01). The areas under the curves (AUCs) of the ordinal and dichotomized CTP-ASPECTS were higher than that of the other two methods (all p < 0.01), but the AUCs of the Auto-ASPECTS was similar to that of the NCCT-ASPECTS (p > 0.05). Conclusions The CTP-ASPECTS is superior to the Auto- and NCCT-ASPECTS in detecting EICs in LVO. CTP-ASPECTS with a cutoff value of 6 is a good predictor of the clinical outcome at 90-day follow-up.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussioncontrasting

confidence: 89%

See 1 more Smart Citation

CT perfusion based ASPECTS improves the diagnostic performance of early ischemic changes in large vessel occlusion

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The baseline ASPECTS is a reliable predictor of the prognosis in patients with AIS [ 28 ]. ASPECTS has been included in the decision-making and assessment of neurovascular interventions in patients with AIS [ 3 ]. In the present study, we try to correlate ASPECTS with stroke subtypes, outcomes, and cognitive impairment in AIS.…”

Section: Discussionmentioning

confidence: 99%

“…The ASPECTS was initially developed for the evaluation of the severity of early ischemic changes in cases with acute ischemic stroke (AIS) [ 3 ]. The ASPECTS evaluation has been increasingly involved in the choice of endovascular treatment [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of the Alberta Stroke Program Early CT Score (ASPECTS) in the Outcome of the Acute Ischemic Stroke and Its Correlation with Stroke Subtypes, NIHSS, and Cognitive Impairment

Esmael

Elsherief

Eltoukhy

2021

Stroke Research and Treatment

View full text Add to dashboard Cite

Objectives. This study is aimed at correlating ASPECTS with mortality and morbidity in patients with acute middle cerebral artery territory infarction and at determining the cutoff value of ASPECTS that may predict the outcome. Methods. 150 patients diagnosed with acute middle cerebral artery territory infarction were involved in this study. Risk factors, initial NIHSS, and GCS were determined. An initial or follow-up noncontrast CT brain was done and assessed by ASPECTS. Outcomes were determined by mRS during the follow-up of cases after 3 months. Correlations of ASPECTS and outcome variables were done by Spearman correlation. Logistic regression analysis and ROC curve were done to detect the cutoff value of ASPECTS that predicts unfavorable outcomes. Results. The most common subtypes of ischemic strokes were lacunar stroke in 66 patients (44%), cardioembolic stroke in 39 patients (26%), and LAA stroke in 30 cases (20%). The cardioembolic stroke had a statistically significant lower ASPECT score than other types of ischemic strokes ( P < 0.05 ). Spearman correlation showed that lower ASPECTS values (worse outcome) were more in older patients and associated with lower initial GCS. ASPECTS values were inversely correlated with initial NIHSS, inpatient stay, inpatient complications, mortality, and mRS. The ASPECTS cutoff value determined for the prediction of unfavorable outcomes was equal to ≤7. The binary logistic regression analysis detected that patients with ASPECTS ≤ 7 were significantly associated with about fourfold increased risk of poor outcomes (OR 3.95, 95% CI 2.09–11.38, and P < 0.01 ). Conclusions. ASPECTS is a valuable and appropriate technique for the evaluation of the prognosis in acute ischemic stroke. Patients with high ASPECTS values are more likely to attain favorable outcomes, and the cutoff value of ASPECTS is a strong predictor for unfavorable outcomes. This trial is registered with ClinicalTrials.gov NCT04235920.

show abstract

External Validation of e‐ASPECTS Software for Interpreting Brain CT in Stroke

Mair

White

Bath

et al. 2022

Annals of Neurology

View full text Add to dashboard Cite

Objective: The purpose of this study was to test e-ASPECTS software in patients with stroke. Marketed as a decisionsupport tool, e-ASPECTS may detect features of ischemia or hemorrhage on computed tomography (CT) imaging and quantify ischemic extent using Alberta Stroke Program Early CT Score (ASPECTS). Methods: Using CT from 9 stroke studies, we compared software with masked experts. As per indications for software use, we assessed e-ASPECTS results for patients with/without middle cerebral artery (MCA) ischemia but no other cause of stroke. In an analysis outside the intended use of the software, we enriched our dataset with non-MCA ischemia, hemorrhage, and mimics to simulate a representative "front door" hospital population. With final diagnosis as the reference standard, we tested the diagnostic accuracy of e-ASPECTS for identifying stroke features (ischemia, hyperattenuated arteries, and hemorrhage) in the representative population. Results: We included 4,100 patients (51% women, median age = 78 years, National Institutes of Health Stroke Scale [NIHSS] = 10, onset to scan = 2.5 hours). Final diagnosis was ischemia (78%), hemorrhage (14%), or mimic (8%). From 3,035 CTs with expert-rated ASPECTS, most (2084/3035, 69%) e-ASPECTS results were within one point of experts. In the representative population, the diagnostic accuracy of e-ASPECTS was 71% (95% confidence interval [CI] = 70-72%) for detecting ischemic features, 85% (83-86%) for hemorrhage. Software identified more false positive ischemia (12% vs 2%) and hemorrhage (14% vs <1%) than experts. Interpretation: On independent testing, e-ASPECTS provided moderate agreement with experts and overcalled stroke features. Therefore, future prospective trials testing impacts of artificial intelligence (AI) software on patient care and outcome are required before widespread implementation of stroke decision-support software.

show abstract

Automated ASPECTS in Acute Ischemic Stroke: A Comparative Analysis with CT Perfusion

Cited by 31 publications

References 37 publications

CT perfusion based ASPECTS improves the diagnostic performance of early ischemic changes in large vessel occlusion

CT perfusion based ASPECTS improves the diagnostic performance of early ischemic changes in large vessel occlusion

Predictive Value of the Alberta Stroke Program Early CT Score (ASPECTS) in the Outcome of the Acute Ischemic Stroke and Its Correlation with Stroke Subtypes, NIHSS, and Cognitive Impairment

External Validation of e‐ASPECTS Software for Interpreting Brain CT in Stroke

Contact Info

Product

Resources

About