Multimodal CT Imaging Characteristics in Predicting Prognosis of Wake-Up Stroke

Abstract

Background: Multimodal CT imaging can evaluate cerebral hemodynamics and stroke etiology, playing an important role in predicting prognosis. This study aimed to summarize the comprehensive image characteristics of wake-up stroke (WUS), and to explore its value in prognostication.Methods: WUS patients with anterior circulation large vessel occlusion were recruited into this prospective study. According to the 90-day modified Rankin Scale (mRS), all patients were divided into good outcome (mRS 0–2) or bad (mRS 3–6). Baseline clinical information, multimodal CT imaging characteristics including NECT ASPECTS, clot burden score (CBS), collateral score, volume of penumbra and ischemic core on perfusion were compared. Multivariate logistic regression analysis was further used to analyze predictive factors for good prognosis. Area under curve (AUC) was calculated from the receiver operating characteristic (ROC) curve to assess prognostic value.Results: Forty WUS were analyzed in this study, with 20 (50%) achieving good outcome. Upon univariable analysis, the good outcome group demonstrated higher ASPECTS, higher CBS, higher rate of good collateral filling and lower penumbra volume when compared with the poor outcome group. Upon logistic regression analysis, poor outcome significantly correlated with penumbra volume (OR: 1.023, 95% CI = 1.003–1.043) and collateral score (OR: 0.140, 95% CI = 0.030–0.664). AUC was 0.715 for penumbra volume (95% CI, 0.550–0.846) and 0.825 for good collaterals (95% CI, 0.672–0.927) in predicting outcome.Conclusions:Penumbra volume and collateral score are the most relevant baseline imaging characters in predicting outcome of WUS patients. These imaging characteristics might be instructive to treatment selection. As the small sample size of current study, further studies with larger sample size are needed to confirm these observations.

Association of Lesion Topography with Functional Outcomes in Acute Ischemic Stroke Patients Considered for, or Receiving, Reperfusion Therapy: A Meta-Analysis

“…Our meta-analysis revealed a clear association of decreasing ASPECTS with odds of poor functional outcomes regardless of the RT received. This is in line with the previous studies that found that decreased ASPECTS are associated with worse functional outcomes [ 16 , 19 , 22 , 33 , 35 , 38 ]. Despite the study design and cohort size, most of the included studies in this meta-analysis found a significant relationship between poor functional outcomes and ASPECTS cut-off points of 6 [ 27 , 30 , 36 , 37 , 38 ], 7 [ 24 , 25 , 26 , 34 , 38 ] and 8 [ 6 , 23 , 29 , 31 , 38 ].…”

“…The 6 studies, comprising 735 patients, included in the meta-analysis demonstrated that there was a significant association of increasing ASPECTS with poor functional outcomes at 90 days (SMD = −1.15; 95% CI −1.77–−0.52; p < 0.0001) ( Figure 3 ) [ 16 , 19 , 22 , 33 , 35 , 38 ]. Moderate to considerable heterogeneity was found between the studies (I 2 = 93.1%, p < 0.0001).…”

“… Forest plot of estimated effect for the association of: ( A ) ASPECTS < 6 [ 27 , 30 , 36 , 37 , 38 ], ( B ) ASPECTS < 7 [ 24 , 25 , 26 , 34 , 38 ], ( C ) ASPECTS < 8 [ 6 , 23 , 29 , 31 , 38 ] and ( D ) continuous ASPECTS [ 16 , 19 , 22 , 33 , 35 , 38 ] with functional outcome at 90 days (mRS 90 days) in acute ischaemic stroke patients receiving, or considered for, reperfusion therapy. Note: IVT ± EVT: All patients received IVT, with or without EVT.…”

“…Figure S1: Schematic of ASPECTS; Figure S2: Influence of single studies on the overall meta-analysis; Table S1: Summary of significant meta-analysis outcomes; Table S2: Summary data and performance estimates for selectivity and specificity analysis; Table S3: Egger’s test for publication bias assessment of the included studies; Table S4: Jaded analysis for methodological quality/risk of bias and test for funding bias. References [ 6 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 44 ] are cited in the supplementary materials.…”