Combined Evaluation of Noncontrast CT ASPECTS and CT Angiography Collaterals Improves Detection of Large Infarcts in Proximal Artery Occlusive Stroke

Mehrkhani, Farhad; Berkhemer, Olvert A.; Majoie, Charles B. L. M.; Mansouri, Mohammad; Karimi, Zahra; Lev, Michael H.; Yoo, Albert J.

doi:10.1111/jon.12522

“…To exclude larger infarct cores, combining ASPECTS and collateral scores did not give added predictive benefits. Contrary to our results, a recent study identified patients with infarct volumes >100 ml with high accuracy using both NECT ASPECTS 0–4 and a malignant CT collateral profile of absent collaterals in >50% of the M2 territory 15 . However, those authors used a DWI-based infarct volume.…”

Section: Discussioncontrasting

confidence: 99%

Optimal Multiphase Computed Tomographic Angiography-based Infarct Core Estimations for Acute Ischemic Stroke

Lee

¹

,

Jung

²

,

Choi

³

et al. 2019

Sci Rep

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We evaluated the best methods for predicting various infarct core thresholds for endovascular treatment of ischemic stroke using parameters obtained by multiphase computed tomographic angiography (mCTA). Consecutive patients evaluated for endovascular treatment who concomitantly underwent mCTA and stroke magnetic resonance imaging (MRI) were analyzed. The ability of CTA-based collaterals (single-phase [sCTAc] and multiphase [mCTAc]) and ASPECTS or their combined interpretation for the selection of patients with cores of <31 ml and <70 ml, and ≥100 ml, were compared. In the total 142 patients, the combined interpretation of collateral scores and ASPECTS score indicated significant added benefit for the prediction of smaller infarct volume thresholds (<31 ml) compared to ASPECTS alone. Selection of cases that satisfied both sCTAc 3–5 and ASPECTS 6–10 had the optimal predictive capability and inter-rater reliability. While the combined interpretation did not provide a significant added benefit for the prediction of larger infarct volume thresholds, sCTAc 0–2 and mCTAc 0–2 performed as well as ASPECTS 0–5 in prediction of core volumes ≥100 ml with better inter-rater reliability. sCTA and mCTA can improve the selection of patients for EVT by more accurately predicting lower infarct core volume cutoffs. When excluding patients with large infarct cores, they can improve inter-rater reliability.

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“…The following imaging information was collected: ASPECTS scores [ 14 ], ischemic penumbra (IP) volume, ischemic core (IC) volume, the mismatch ratio (MMR) [ 15 ], the modified collateral circulation scoring system on 4D CTA (4D CTA-CS) scores [ 8 ], clot burden score (CBS) scores [ 16 ], and the final infarct volume (FIV) [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Collateral Circulation and BNP in Predicting Outcome of Acute Ischemic Stroke Patients with Atherosclerotic versus Cardioembolic Cerebral Large-Vessel Occlusion Who Underwent Endovascular Treatment

Cao

¹

,

Lu

²

,

Qi

³

et al. 2023

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Purpose: The aim of this study was to verify the value of collateral circulation and B-type natriuretic peptide (BNP) in predicting clinical outcomes of patients with acute ischemic stroke (AIS) and their biomarker value for stroke subtypes before endovascular treatment (EVT). Patients and Methods: In this retrospective study, 182 patients who underwent EVT for unilateral anterior circulation large-vessel occlusion between March 2016 and January 2022 were analyzed. The modified collateral circulation scoring system on four-dimensional computed tomography angiography (4D CTA-CS) was used to assess collateral status, and stroke subtypes were determined according to the TOAST classification criteria. Patients were divided into good (mRS ≤ 2) and poor outcome (mRS > 2) groups based on their modified Rankin Scale (mRS) score at 3 months. Results: 4D CTA-CS was an independent predictor of the clinical outcome for all AIS patients (odds ratio = 0.253; 95% CI, 0.147–0.437; p < 0.001), CE stroke patients (odds ratio = 0.513; 95% CI, 0.280–0.939; p = 0.030), and LAA stroke patients (odds ratio = 0.148; 95% CI, 0.049–0.447; p = 0.001). The BNP was a biomarker for clinical outcome prediction in CE (odds ratio = 1.004; 95% CI, 1.001–1.008; p = 0.005) but not in LAA patients. Combined with BNP, 4D CTA-CS improved predictive values for clinical outcomes (p < 0.05). Conclusion: Collateral status and BNP could be used as independent predictors of clinical outcomes in AIS patients and could determine stroke subtypes (CE stroke or LAA stroke). In addition, the model of 4D CTA-CS combined with BNP was the most effective in predicting clinical outcomes compared with collateral status or BNP alone.

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“…ASPECTS [ 14 ] was used to assess early ischemic changes. Vitrea (Vital Images, Minnetonka, Minnesota) was utilized for obtaining CTP parameters, including cerebral blood volume (CBV) and time to peak (TTP).…”

Section: Methodsmentioning

confidence: 99%

BNP on Admission Combined with Imaging Markers of Multimodal CT to Predict the Risk of Cardioembolic Stroke

Cao

¹

,

Jiang

²

,

Li

³

et al. 2022

Disease Markers

1

0

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Background. The aim of the study was to find the potential roles of B-type natriuretic peptide (BNP) and imaging markers on distinguishing cardioembolic (CE) stroke from non-CE stroke, so as to provide useful information for making individualized endovascular treatment (EVT) plan for the patients with acute ischemic stroke (AIS). Methods. The patients with unilateral anterior circulation large vessel occlusion who underwent EVT between March 2016 and December 2021 were analyzed in this study, retrospectively. The risk factors, laboratory test indicators, imaging parameters, and other factors were compared between the CE group and non-CE group. Logistic regression was used to analyze the risk factors of CE stroke. ROC curves were used to assess the values of different parameters on distinguishing CE stroke from non-CE stroke. The relationships between BNP and imaging parameters were assessed using the Spearman correlation analysis. Results. 160 patients were enrolled in the study and divided into the CE group ( n = 66 ) and non-CE group ( n = 94 ). BNP (odds ratio OR = 1.004 ; 95% CI, 1.001-1.009; p = 0.038 ), MMR ( OR = 0.736 ; 95% CI, 0.573-0.945; p = 0.016 ), NIHSS ( OR = 1.150 ; 95% CI, 1.022-1.294; p = 0.020 ), and AF ( OR = 556.968 ; 95% CI, 51.739-5995.765; p < 0.001 ) were the independent predictive factors of CE stroke. The area under the curve (AUC) of BNP and mismatch ratio (MMR) were 0.846 (95% CI (0.780-0.898), p < 0.001 ) and 0.636 (95% CI (0.633-0.779), p < 0.001 ), respectively. The cut-off value of BNP was 249.23 pg/mL with the sensitivity of 74.24% and the specificity of 82.98%. BNP combined with MMR improved the predictive value for CE stroke. The AUC of the combination was 0.858 with the sensitivity of 84.85% and the specificity of 73.40%. BNP was correlated with 4D CTA collateral score, MMR, clot burden score, final infarct volume, infarct core volume, and ischemic penumbra volume (all, p < 0.05 ). Conclusion. BNP on admission combined with MMR is valuable for the risk prediction of CE stroke, which will promote the further screening of the high-risk patients with CE stroke and provide more diagnostic information for clinicians.

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Combined Evaluation of Noncontrast CT ASPECTS and CT Angiography Collaterals Improves Detection of Large Infarcts in Proximal Artery Occlusive Stroke

Abstract: Combined evaluation of NCCT ASPECTS and CTA collaterals identifies patients with infarcts >100 mL with high accuracy, and can improve patient selection using current CT techniques.

Cited by 4 publications

References 24 publications

Optimal Multiphase Computed Tomographic Angiography-based Infarct Core Estimations for Acute Ischemic Stroke

Optimal Multiphase Computed Tomographic Angiography-based Infarct Core Estimations for Acute Ischemic Stroke

Collateral Circulation and BNP in Predicting Outcome of Acute Ischemic Stroke Patients with Atherosclerotic versus Cardioembolic Cerebral Large-Vessel Occlusion Who Underwent Endovascular Treatment

BNP on Admission Combined with Imaging Markers of Multimodal CT to Predict the Risk of Cardioembolic Stroke

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