Published online before print October 14, 2004, doi: 10.1161/01.STR.0000145330.14928.2a
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(Stroke. 2004;35:2472.)
© 2004 American Heart Association, Inc.
Original Contributions |
ASPECTS on CTA Source Images Versus Unenhanced CT
Added Value in Predicting Final Infarct Extent and Clinical Outcome
From the Seaman Family MR Research Centre (S.B.C., A.M.B., A.M.D.), Foothills Medical Centre, Calgary Health Region; the Departments of Clinical Neurosciences (S.B.C., M.E., M.D.H., J.H.W.P., M.E.H., A.M.B., A.M.D.), Medicine and Community Health Sciences (M.E., M.D.H.), and Radiology (M.E.H.), University of Calgary, Alberta, Canada; and the Departments of Radiology (M.H.L., L.R., R.G.G.) and Neurology (L.H.S., W.J.K.), Massachusetts General Hospital, Harvard Medical School, Boston.
Correspondence to Dr Shelagh Coutts, Seaman Family MR Centre, Foothills Hospital, 1403 29th ST NW, Calgary, Alberta T2N 2T9. E-mail shelagh.coutts{at}calgaryhealthregion.ca
Background and Purpose— The Alberta Stroke Program Early CT Score (ASPECTS) is a grading system to assess ischemic changes on CT in acute ischemic stroke. CT angiography–source images (CTA-SI) predict final infarct volume. We examined whether the final infarct ASPECTS and clinical outcome were more related to acute CTA-SI ASPECTS than to the acute noncontrast CT (NCCT) ASPECTS.
Methods— ASPECTS was assigned by 2 raters on the acute NCCT, CTA-SI, and follow-up imaging. The mean baseline ASPECTS of acute NCCT and CTA-SI was compared with the follow-up ASPECTS. Rate ratios (RRs) were used to quantify the relationship between the dichotomized baseline ASPECTS (categorized as 0 to 7 versus 8 to 10) and favorable patient outcome.
Results— Thirty-nine patients were recruited. Proximal occlusion (internal carotid artery or middle cerebral artery) was seen in 62%, M2 occlusion in 18%, and no occlusion was seen in 20% of patients. The median time between symptom onset and imaging was 1.9 (1.2 to 2.5) hours. There was a significantly larger difference of 1.4 between the mean baseline NCCT and CTA-SI ASPECTS in patients who had more ischemic changes (follow-up ASPECTS=0 to 3) than a difference of 0.6 in patients who had near-to-normal CT scans (follow-up ASPECTS=8 to 10). The rate of favorable outcome for acute NCCT ASPECTS of 8 to 10 was 51.8% versus 25.0% for 0 to 7 (RR, 2.1, 95% CI: 0.7 to 5.9, P=0.12). For acute CTA-SI ASPECTS of 8 to 10, the rate of favorable outcome was 58.8% versus 31.8% for 0 to 7 (RR, 1.8, 95% CI: 0.9 to 3.8, P=0.09).
Conclusions— CTA-SI ASPECTS provides added information in the prediction of final infarct size.
Key Words: computed tomography • stroke, acute • thrombolysis
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