The clot burden score, the Boston Acute Stroke Imaging Scale, the cerebral blood volume ASPECTS, and two novel imaging parameters in the prediction of clinical outcome of ischemic stroke patients receiving intravenous thrombolytic therapy

Abstract

CBS, BASIS, and CBV ASPECTS are statistically robust and sensitive but unspecific predictors of good clinical outcome. Two new derived imaging parameters, CBSV and M1-BASIS, share these properties and may have increased prognostic value.

Performance and Predictive Value of a User-Independent Platform for CT Perfusion Analysis: Threshold-Derived Automated Systems Outperform Examiner-Driven Approaches in Outcome Prediction of Acute Ischemic Stroke

“…10,20 Two previously proposed CTA-derived measures, the clot burden score and collateral score, were investigated among triage variables in this study. 9,11,21 While previously having shown promise as outcome predictors, their ability to supplant tissuelevel information provided by perfusion imaging may be limited by uncertainty as to the nutritive capacity of surface-level collaterals vis-à-vis the tissue perfusion approximated by dynamic bolus passage deconvolution with an arterial input function. The importance of leptomeningeal collateral flow in preserving ischemic neuronal substrate and potentially protecting against hemorrhage has been discussed, and numerous multimodal collateral scoring methodologies have been proposed but may lack in their ability to characterize the dynamic nature of collateral flow or discriminate nonperfusion from flow delayed at the moment of acquisition.…”

“…[4][5][6][7] With studies further complicated by the time, materials, and expertise requisite to successfully undertake perfusion imaging, some investigators have focused on triage algorithms examining more readily attainable biomarkers derived from noncontrast CT (eg, Alberta Stroke Program Early CT Score) or CT angiography (eg, collateral score [CS], clot burden score [CBS]) common to stroke protocols. [8][9][10][11] While quickly attainable, the performance of ASPECTS in triaging patients to therapy or predicting outcome has been variable, and its use in prognostication of individual outcomes has been questioned. [12][13][14] Similarly, CS…”

“…[9][10][11] Recently, the ASPECTS methodology was applied to CTP parametric maps in an effort to impart standardization and mitigate subjective elements of perfusion analysis; however, even in this context, the strengths of perfusion imaging may be attenuated by variability in postprocessing, computational analysis, selection of parametric maps, and the generally qualitative nature of such approaches. 10,11 Expert consensus has emphasized the demand for standardization in the acquisition, processing, and analysis of perfusion imaging.…”

“…[9][10][11] Recently, the ASPECTS methodology was applied to CTP parametric maps in an effort to impart standardization and mitigate subjective elements of perfusion analysis; however, even in this context, the strengths of perfusion imaging may be attenuated by variability in postprocessing, computational analysis, selection of parametric maps, and the generally qualitative nature of such approaches. 10,11 Expert consensus has emphasized the demand for standardization in the acquisition, processing, and analysis of perfusion imaging. 15,16 The potential for disparate results and the variability in accuracy among competing software platforms have been the subject of recent studies and were thoroughly expounded in a comparative analysis by Kudo et al 17 In light of recent reports, the primary objective of this study were to examine the predictive performance of several user-defined approaches to NCCT, CTA, and CTP analysis, by comparison with a fast, vendor-and operator-independent computational tool using fully automated lesion segmentation and pixel-wise parametric thresholding for semiquantitation (RApid processing of PerfusIon and Diffusion [RAPID]).…”

Multimodal imaging protocols and their predictive role in acute stroke functional outcome

“…Однако изолированная окклюзия ВСА (без вовлечения пе-редней хориоидальной артерии) независимо ассо-циирована с БФИ [56][57][58][59][60][61]. Установлено, что шкалы BASIS и CBS превосходят ASPECTS в отношении прогнозирования ФИ, при этом CBS имеет боль-шую чувствительность, а BASIS -специфичность [62][63][64][65]. ФИ напрямую коррелирует как со степе-нью коллатерального кровотока, так и реканализа-цией артерий, так как от них напрямую зависит КОИ [66][67][68][69][70].…”