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

Abstract

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.

Predictors of Early Neurological Improvement in Patients with Anterior Large Vessel Occlusion and Successful Reperfusion Following Endovascular Thrombectomy—Does CT Perfusion Imaging Matter?

“…Thus, baseline CT ASPECTS appears to be more accurate and reproducible in patients presenting with a late time window > 6 h. On the contrary, the ischemic change of brain could be reliably assessed with CTP ASPECTS, which assessed the extent of ischemic core as areas with less than 30% CBF. Another advantage of CTP ASPECTS over NCCT ASPECTS is the increased diagnostic confidence and concordance of the readers in interpreting the imaging, as detection of early signs of cerebral ischemia on NCCT, such as subtle hypoattenuation or swelling, requires years of reading experience in acute stroke [ 5 , 28 ]; however, additional radiation exposure and contrast agent administration as well as prolonged examination time by CTP imaging are known disadvantages in the workflow of stroke management. With the aid of artificial intelligence, accuracy of NCCT ASPECTS calculation might be improved in patients presenting in an early time window [ 29 ].…”

“…Moreover, we aimed to assess predictors associated with favorable early neurological improvement (ENI) in patients with successful reperfusion following EVT. Particular attention was given to cerebral CT perfusion (CTP) imaging, which enables a more reliable assessment of ischemic change, as non-contrast CT (NCCT) often shows no or only subtle infarct demarcation at baseline, especially in patients with an early time window < 3 h [ 5 , 6 ]. Based on our own observation, we hypothesized that CTP-derived parameters at baseline might be more predictive of clinical outcome than NCCT.…”

Basilar artery occlusion: A review of clinicoradiologic features, treatment selection, and endovascular techniques

“…31 CTP -ASPECTS may offer a better status of the ischemic region when compared to NCCT-ASPECTS since CTP provides quantitative parameters that may better define the ischemic penumbra and infarct core. 32 Caruso et al noted that pc-ASPECTS on CTP appeared to be a powerful marker for predicting functional outcome. They applied pc-ASPECTS to NCCT, CTA, and CTP.…”

Predicting intracerebral hemorrhage after endovascular therapy for anterior circulation strokes using CT-ASPECT, CTP-ASPECT and DWI-ASPECT: Protocol for a systematic review

“…The Alberta Stroke Program Early CT Score (ASPECT) is commonly used to interpret CT scans (CT-ASPECT) in acute stroke management, given its role in predicting patients’ prognosis post-reperfusion therapy [ 15 ]. The ASPECT score has been transposed onto other imaging modalities such as CT-Perfusion scan (CTP-ASPECT) and MRI scan (DWI-ASPECT), where it has also been proven to be a reliable predictor of clinical outcomes [ 16 , 17 ]. Individual studies suggest the ASPECT score may help predict the risk of post-thrombectomy ICH, but there have been no attempts to formally evaluate the existing literature.…”