Published online before print November 14, 2002, doi: 10.1161/01.STR.0000043074.39077.60
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(Stroke. 2002;33:2819.)
© 2002 American Heart Association, Inc.
Original Contributions |
MOSAIC: Multimodal Stroke Assessment Using Computed Tomography
Novel Diagnostic Approach for the Prediction of Infarction Size and Clinical Outcome
From the Departments of Neurology (D.G.N., E.-M.N., E.B.R.) and Clinical Radiology (S.P.K., M.F., C.G.G., W.H.), University of Münster, Münster, and Siemens, Medical Solutions (E.K.), Forchheim, Germany.
Correspondence to Priv-Doz Darius G. Nabavi, MD, Department of Neurology, University of Münster, Albert Schweitzer-Str 33, D-48129 Münster, Germany. E-mail nabavi{at}uni-muenster.de
Background and Purpose— With new CT technologies, including CT angiography (CTA), perfusion CT (PCT), and multidetector row technique, this method has regained interest for use in acute stroke assessment. We have developed a score system based on Multimodal Stroke Assessment Using CT (MOSAIC), which was evaluated in this prospective study.
Methods— Forty-four acute stroke patients (mean age, 63.8 years) were enrolled within a mean of 3.0±1.9 hours after symptom onset. The MOSAIC score (0 to 8 points) was generated by results of the 3 sequential CT investigations: (1) presence and amount of early signs of infarction on noncontrast CT (NCCT; 0 to 2 points), (2) stenosis (>50%) or occlusion of the distal internal carotid or middle cerebral artery on CTA (0 to 2 points), and (3) presence and amount of reduced cerebral blood flow on 2 adjacent PCT slices (0 to 4 points). The predictive value of the MOSAIC score was compared with each single CT component with respect to the final size of infarction and the clinical outcome 3 months after stroke by use of the modified Rankin Scale (mRS) and the Barthel Index (BI).
Results— Among the CT components, PCT showed the best correlation to infarction size (r=0.75) and clinical outcome (r=0.60 to 0.62) compared with NCCT (r=0.43 to 0.58) and CTA (r=0.47 to 0.71). The MOSAIC score showed consistently higher correlation factors (r=0.67 to 0.78) and higher predictive values (0.73 to 1.0) than all single CT components with respect to outcome measures. A MOSAIC score <4 predicted independence with 89% to 96% likelihood (mRS 
2, BI 
90); a MOSAIC score <5 predicted fair outcome with 96% to 100% likelihood (mRS 3, BI 60).
Conclusions— The MOSAIC score based on multidetector row CT technology is superior to NCCT, CTA, and PCT in predicting infarction size and clinical outcome in hyperacute stroke.
Key Words: angiography • brain stem infarction • cerebral blood flow • computed tomography • outcome
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