Correlation between ASPECTS and Core Volume on CT Perfusion: Impact of Time since Stroke Onset and Presence of Large-Vessel Occlusion

Nannoni, Stefania; Ricciardi, Federico; Strambo, Davide; Gaia, Silvia; Wintermark, Max; Dunet, Vincent; Michel, Patrik

doi:10.3174/ajnr.a6959

Cited by 41 publications

(39 citation statements)

References 38 publications

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“…Details on the neuroimaging protocol of each participating center, ASPECTS scoring and adopted EVT guidelines have been published before, 12,13 and additional information are provided in the Supplementary Material.…”

Section: Study Design and Study Populationmentioning

confidence: 99%

ASPECTS-based selection for late endovascular treatment: a retrospective two-site cohort study

Nannoni

Kaesmacher

Ricciardi

et al. 2021

International Journal of Stroke

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Introduction The DAWN trial demonstrated the effectiveness of late endovascular treatment (EVT) in acute ischemic stroke (AIS) patients selected on the basis of a clinical-core mismatch. We explored in a real-world sample of EVT patients if a clinical-ASPECTS (Alberta Stroke Program Early CT Score) mismatch was associated with an outcome benefit after late EVT. Methods We retrospectively analysed all consecutive AIS patients admitted 6-24 hours after last proof of good health in two stroke centres, with initial National Institutes of Health Stroke Scale (NIHSS) â¥10 and an internal carotid artery or M1 occlusion. We defined clinical-ASPECTS mismatch as NIHSSâ¥10 and ASPECTSâ¥7, or NIHSSâ¥20 and ASPECTSâ¥5. We assessed the interaction between clinical-ASPECTS mismatch positive and negative patients and late EVT, using ordinal shift analysis of the 3-month modified Rankin Scale and adjusting for multiple confounders. Results The included 337 patients had a median age of 73 years (IQR=61-82), admission NIHSS of 18 (15-22) and baseline ASPECTS of 7 (5-9). Out of 196 (58.2%) patients showing clinical-ASPECTS mismatch, 146 (74.5%) underwent late EVT. Among 141 (41.8%) mismatch negative patients, late EVT was performed in 72 (51.1%) patients. In the adjusted analysis, late EVT was significantly associated with a better outcome in the presence of clinical-ASPECTS mismatch (adjusted Odd Ratio, aOR=2.83; 95% confidence interval, CI: 1.48-5.58) but not in its absence (aOR=1.32; 95%CI: 0.61-2.84). The p-value for the interaction term between clinical-ASPECTS mismatch and late EVT was 0.073. Conclusions In our retrospective two-site analysis, late EVT seemed effective in the presence of a clinical-ASPECTS mismatch, but not in its absence. If confirmed in randomized trials, this finding could support the use of an ASPECTS-based selection for late EVT decisions, obviating the need for advanced imaging.

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Section: Study Design and Study Populationmentioning

confidence: 99%

ASPECTS-based selection for late endovascular treatment: a retrospective two-site cohort study

Nannoni

Kaesmacher

Ricciardi

et al. 2021

International Journal of Stroke

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“…Prior studies, on the other hand, have shown improved performance of NCHCT-ASPECTS with increasing time after last known well. 20…”

Section: Discussionmentioning

confidence: 99%

Automated prediction of final infarct volume in patients with large-vessel occlusion acute ischemic stroke

Abdelkhaleq¹,

Kim²,

Khose³

et al. 2021

Neurosurgical Focus

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OBJECTIVE In patients with large-vessel occlusion (LVO) acute ischemic stroke (AIS), determinations of infarct size play a key role in the identification of candidates for endovascular stroke therapy (EVT). An accurate, automated method to quantify infarct at the time of presentation using widely available imaging modalities would improve screening for EVT. Here, the authors aimed to compare the performance of three measures of infarct core at presentation, including an automated method using machine learning. METHODS Patients with LVO AIS who underwent successful EVT at four comprehensive stroke centers were identified. Patients were included if they underwent concurrent noncontrast head CT (NCHCT), CT angiography (CTA), and CT perfusion (CTP) with Rapid imaging at the time of presentation, and MRI 24 to 48 hours after reperfusion. NCHCT scans were analyzed using the Alberta Stroke Program Early CT Score (ASPECTS) graded by neuroradiology or neurology expert readers. CTA source images were analyzed using a previously described machine learning model named DeepSymNet (DSN). Final infarct volume (FIV) was determined from diffusion-weighted MRI sequences using manual segmentation. The primary outcome was the performance of the three infarct core measurements (NCHCT-ASPECTS, CTA with DSN, and CTP-Rapid) to predict FIV, which was measured using area under the receiver operating characteristic (ROC) curve (AUC) analysis. RESULTS Among 76 patients with LVO AIS who underwent EVT and met inclusion criteria, the median age was 67 years (IQR 54–76 years), 45% were female, and 37% were White. The median National Institutes of Health Stroke Scale score was 16 (IQR 12–22), and the median NCHCT-ASPECTS on presentation was 8 (IQR 7–8). The median time between when the patient was last known to be well and arrival was 156 minutes (IQR 73–303 minutes), and between NCHCT/CTA/CTP to groin puncture was 73 minutes (IQR 54–81 minutes). The AUC was obtained at three different cutoff points: 10 ml, 30 ml, and 50 ml FIV. At the 50-ml FIV cutoff, the AUC of ASPECTS was 0.74; of CTP core volume, 0.72; and of DSN, 0.82. Differences in AUCs for the three predictors were not significant for the three FIV cutoffs. CONCLUSIONS In a cohort of patients with LVO AIS in whom reperfusion was achieved, determinations of infarct core at presentation by NCHCT-ASPECTS and a machine learning model analyzing CTA source images were equivalent to CTP in predicting FIV. These findings have suggested that the information to accurately predict infarct core in patients with LVO AIS was present in conventional imaging modalities (NCHCT and CTA) and accessible by machine learning methods.

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“…Nannoni et al reported that NCCT ASPECTS correlated signi cantly with the CTP infarct core, especially in the AIS patients with late window and large-vessel occlusion. Therefore, they concluded that the use of ASPECTS could be a surrogate maker of CTP core in late-arriving AIS patients with large-vessel occlusion [14]. In addition, simulated multiphase CTA reconstructed from CTP raw data was also reported to be useful in re ecting the perfusion information to a certain extent.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Time Usage and Success Rate Between CT Angiography- and CT Perfusion- Based Imaging Assessment Strategy for the Patients with Acute Ischemic Stroke

Chu¹,

Ma²,

Xu³

et al. 2021

Preprint

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Background: Our study aimed to compare the time usage and success rate between CTA- and CTP- based assessment strategy, and to clarify the risk factors associated with CTP scan failure. Methods: Clinical and radiological data of 437 consecutive AIS patients who underwent multiphase CTA or CTP for pre-treatment evaluation were retrospectively enrolled (CTA group, n=302; CTP group, n=135). Time usage and success rate of CTA and CTP were compared using Mann-Whitney U test and Chi-Squared Test. Univariate analysis and receiver operating curve analysis were used to clarify the risk factors and their values for predicting CTP scan failure.Results: Time usage of CTP scan and reconstruction was significantly longer than that of CTA [775sec vs 263.5sec, P<0.001]. CTP scan showed significantly higher failure rate than CTA (11% vs 1%, P<0.001). Severe motion was the most common cause of CTP failure (n=12, 80%). Baseline National Institute of Health Stroke Scale (NIHSS) score in CTP failure group was significantly higher than that in CTP success group [17 vs 13, P=0.007]. Baseline NIHSS score of 11 was the optimal threshold to predict CTP failure with an area under the curve of 0.771, sensitivity of 86.7% and specificity of 45.0%.Conclusions: CTP-based strategy showed longer time consumption and higher failure rate than CTA-based strategy. High baseline NIHSS score was significantly associated with CTP scan failure in AIS patients.

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Correlation between ASPECTS and Core Volume on CT Perfusion: Impact of Time since Stroke Onset and Presence of Large-Vessel Occlusion

Cited by 41 publications

References 38 publications

ASPECTS-based selection for late endovascular treatment: a retrospective two-site cohort study

ASPECTS-based selection for late endovascular treatment: a retrospective two-site cohort study

Automated prediction of final infarct volume in patients with large-vessel occlusion acute ischemic stroke

Comparison of Time Usage and Success Rate Between CT Angiography- and CT Perfusion- Based Imaging Assessment Strategy for the Patients with Acute Ischemic Stroke

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