Early CT changes in patients admitted for thrombectomy

Abstract

In patients considered for thrombectomy, there may be insufficient agreement between clinicians for ASPECTS to be reliably used as a criterion for treatment decisions.

Baseline ASPECTS and e‐ASPECTS Correlation with Infarct Volume and Functional Outcome in Patients Undergoing Mechanical Thrombectomy

“…However, in our study, we used the Rx‐ASPECTS scored during the acute stroke evaluation reflecting true clinical practice which we consider a strength as compared with retrospective expert reading. The observed low correlation reflects ASPECTS intrinsic limitations previously reported . Finally, we measured FIV on a control CT scan performed 24 hours after onset instead of on a follow‐up magnetic resonance fluid‐attenuated inversion recovery (FLAIR) imaging, which is considered the gold‐standard for FIV measurements.…”

“…In the hyperacute setting, CT images obtained within the first hours of an acute ischemic stroke might present only subtle signs of cerebral ischemia. Therefore, ASPECTS evaluation requires experienced training and even between experts, ASPECTS presents a poor interrater reliability …”

“…Therefore, ASPECTS evaluation requires expe-rienced training and even between experts, ASPECTS presents a poor interrater reliability. 3,4 An automated software based on machine learning (e-ASPECTS, Brainomix R , Oxford, UK; www.brainomix.com) has been designed to offer a standardized approach to hyperacute stroke image interpretation. 5 This software has proven to be noninferior to expert neuroradiologists using final infarct volume (FIV) as ground-truth, and better than neurology trainees when comparing both scores to MRI diffusionweighted images (DWIs) of acute ischemic stroke.…”

Noncontrast CT versus Perfusion‐Based Core Estimation in Large Vessel Occlusion: The Blood Pressure after Endovascular Stroke Therapy Study

“…Last, all imaging was reviewed at each site by local investigators without central adjudication. The historically reported inter‐rater reliability of individual patient ASPECTS scores in acute stroke has been poor, but it may improve when the ASPECTS is categorized into two or more groups . For this reason, we grouped patients according to the presence of any early infarct signs (ASPECTS <10) and those with unfavorable ASPECTS scores (ASPECTS <6), which should improve the inter‐rater reliability in our cohort.…”

Importance of Reperfusion Status after Intra-Arterial Thrombectomy for Prediction of Outcome in Anterior Circulation Large Vessel Stroke

“…Moreover, recent studies have shown that CT ASPECTS and CT perfusion findings were not independent predictors when reperfusion status was included [11, 38]. CT ASPECTS has limited inter- and intrarater reliability [39] and is less predictive than diffusion-weighted imaging (DWI)-ASPECTS or CT perfusion [40-42]. However, recent studies using MRI DWI-ASPECTS also highlighted the importance of reperfusion status for the prediction of outcome [33, 43].…”