Automated ASPECTS for multi-modality CT predict infarct extent and outcome in large-vessel occlusion stroke. Issue 143 (October 2021)

• Record Type: Journal Article
• Authors: Cheng, XiaoQing; Shi, JiaQian; Wu, Hang; Dong, Zheng; Liu, Jia; Lu, MengJie; Zhou, ChangSheng; Liu, QuanHui; Su, XiaoQin; Shi, Zhao; Li, YingLe; Zhu, WuSheng; Lu, GuangMing
• Is Part Of: European journal of radiology. Issue 143(2021)
• Publication Date: 2021-10
• Subjects: Stroke -- Artificial intelligence -- Computed tomography -- Middle cerebral artery occlusion -- Angiography; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2021.109899
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: CTA-venous-ASPECTS is a reliable tool to predict the infarct extent and outcome. CTA-venous-ASPECTS facilitates treatment decisions after large vessel occlusion. Best sensitivity of mismatch-ASPECTS to predict good outcomes after treatment. Abstract: Purpose: This study aimed to use the automated Alberta Stroke Program Early CT Score (ASPECTS) software to assess the value of different CT modalities (non-contrast CT, CT angiography [CTA]-arterial, CTA-venous, and arterial- and venous-phase mismatch-ASPECTS) in predicting the final infarct extent and clinical outcome in large-vessel occlusion stroke. Methods: This retrospective study included patients with large-vessel occlusion stroke who underwent reperfusion therapy during 2015 to 2019. Correlations between different CT-ASPECTS modalities and follow-up CT-ASPECTS and outcome were determined using Spearman rank correlation coefficient. Receiver operating characteristic curve analysis was used to assess the ability of different CT-ASPECTS modalities to identify patients with good outcomes. Results: One hundred and thirty-five patients were included. We found almost-perfect correlation between CTA-venous-ASPECTS and follow-up CT-ASPECTS (r = 0.92; 95% CI: 0.89–0.95), better than that in other CT modalities. The 90-day modified Rankin scale (mRS) score substantially correlated with CTA-venous-ASPECTS (r = -0.64; 95% CI: −0.73 to −0.52). The ROC curve analysis showed CTA-venous-ASPECTS had the highest area under the curve (AUC: 0.82; 95% CI: 0.75–0.89; P < 0.001), followed by mismatch-ASPECTS (AUC: 0.75; 95% CI: 0.65–0.85; P < 0.001). When emphasizing the sensitivity for identifying patients with good outcomes, the best cut-off point of mismatch-ASPECTS was −3 with the highest sensitivity (91.30%). Conclusions: CTA-venous-ASPECTS is a reliable tool to predict the infarct extent and outcome. Furthermore, mismatch-ASPECTS may represent images in different angiographic phases and was sensitive for prognosis prediction.