A differential detailed diffusion-weighted imaging-ASPECTS for cerebral infarct volume measurement and outcome prediction

Abstract

Background Diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) has been used to estimate infarct core volume in acute stroke. However, the same and indiscriminate score deduction for punctate or confluent DWI-high-intensity lesion might lead to variation in performance. Aims To develop and evaluate a differential detailed DWI-ASPECTS method in comparison with the conventional DWI-ASPECTS in core infarct volume measurement and clinical outcome prediction. Methods We retrospectively recruited patients with acute ischemic stroke (AIS) treated with endovascular treatment between April 2013 and October 2019. In differential detailed DWI-ASPECTS, restricted diffusion lesion that was punctate or less than half of a cortical region (M1- M6) would not lead to subtraction of point. A favourable outcome was modified Rankin score ≤2 at 90 days after stroke onset. Results Among 298 AIS patients, mean age was 75 years (IQR 67–82), and 194 patients (65%) were males. Mean infarct core volume was 11ml (IQR 3–37). Overall, the score by detailed DWI-ASPECTS was significantly higher than conventional DWI-ASPECTS (8 (7–9) vs 7 (5–9); P<0.01). The detailed DWI-ASPECTS resulted in a higher correlation coefficient (r) for core infarct volume estimation than the conventional DWI-ASPECTS (r = 0.832 vs 0.773; P<0.01). Upon re-classification of those scored ≤ 6 in conventional DWI-ASPECTS (n=134) by detailed DWI-ASPECTS, the rate of favourable outcome in patients with detailed DWI-ASPECTS > 6 was significantly higher than those with ≤ 6 (29 (48%) vs 14 (19%) p<0.01). Conclusions Detailed DWI-ASPECTS appeared to provide a more accurate infarct core volume measurement and clinical outcome correlation than conventional DWI-ASPECTS among AIS patients treated with endovascular therapy.

Correlation between DWI-ASPECTS Score, Ischemic Stroke Volume on DWI, Clinical Severity and Short-Term Prognosis: A Single-Center Study

“…For instance, it effectively forecasts the short-term prognosis of patients with acute ischemic stroke treated with iv-tPA [ 16 ]. Modified DWI-ASPECTS scores have shown superior correlation with volume estimation compared to conventional scores [ 17 ], and AI-based calculations have yielded results comparable to manual measurements by experienced neuroradiologists [ 18 ].…”

“…Previous studies have shown a correlation between NIHSS and infarct volume in patients with acute stroke, but there are fewer reports on the degree of disability associated with ischemic volume and NIHSS score [ 17 , 18 , 19 , 20 ]. The aim of this study was to determine if the volume of ischemic lesions, as determined with DWI, was an independent predictor of the degree of disability.…”