Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Neurology. 2010 Aug 10;75(6):555-61. doi: 10.1212/WNL.0b013e3181eccf78.
To evaluate whether the pretreatment Alberta Stroke Programme Early CT Score (ASPECTS) assessed using diffusion-weighted imaging (DWI) predicts stroke outcomes at 3 months following IV recombinant tissue-type plasminogen activator (rt-PA) therapy.
Stroke patients treated with rt-PA (0.6 mg/kg alteplase) in 10 stroke centers in Japan were retrospectively studied. ASPECTS was assessed on DWI just prior to rt-PA injection. The primary outcome was a modified Rankin Scale (mRS) score of 0-2 at 3 months. Secondary outcomes included death at 3 months and symptomatic intracerebral hemorrhage (sICH) within 36 hours.
For the 477 patients (316 men, 71 +/- 11 years old) enrolled, the median NIH Stroke Scale score was 13 (interquartile range 7-18.5), the median ASPECTS on DWI was 8 (7-10), and sICH was identified in 15 patients (3.1%). At 3 months, 245 (51.4%) had an mRS score of 0-2, and 29 (6.1%) had died. Patients with an mRS score of 0-2 had higher median ASPECTS (9; interquartile range 8-10) than other patients (8; 6-9, p < 0.001). Using receiver operating characteristic curves, the optimal cutoff ASPECTS to predict an mRS score of 0-2 was > or =7. On multivariate regression analysis, ASPECTS > or =7 was related to an mRS score of 0-2 (odds ratio 1.85; 95% confidence interval 1.07-3.24), ASPECTS < or =4 was related to death (3.61; 1.23-9.91), and ASPECTS < or =5 was related to sICH (4.74; 1.54-13.64).
ASPECTS on DWI was independently predictive of functional and vital outcomes at 3 months, as well as sICH within 36 hours, following rt-PA therapy for stroke patients.
评估使用弥散加权成像（DWI）评估的预处理阿尔伯塔卒中计划早期 CT 评分（ASPECTS）是否能预测接受 IV 重组组织型纤溶酶原激活剂（rt-PA）治疗后 3 个月的卒中结局。
回顾性研究了在日本 10 个卒中中心接受 rt-PA（0.6mg/kg 阿替普酶）治疗的卒中患者。在 rt-PA 注射前使用 DWI 评估 ASPECTS。主要结局为 3 个月时改良 Rankin 量表（mRS）评分 0-2。次要结局包括 3 个月时的死亡和 36 小时内的症状性颅内出血（sICH）。
共纳入 477 例患者（316 例男性，71±11 岁），NIH 卒中量表评分中位数为 13（四分位距 7-18.5），DWI 上 ASPECTS 中位数为 8（7-10），15 例患者（3.1%）出现 sICH。3 个月时，245 例（51.4%）mRS 评分 0-2，29 例（6.1%）死亡。mRS 评分 0-2 的患者 ASPECTS 中位数较高（9；四分位距 8-10），而其他患者为 8（6-9，p<0.001）。使用受试者工作特征曲线，预测 mRS 评分 0-2 的最佳截断 ASPECTS 值为>或=7。多变量回归分析显示，ASPECTS>或=7 与 mRS 评分 0-2 相关（优势比 1.85；95%置信区间 1.07-3.24），ASPECTS<或=4 与死亡相关（3.61；1.23-9.91），ASPECTS<或=5 与 sICH 相关（4.74；1.54-13.64）。
DWI 上的 ASPECTS 可独立预测 rt-PA 治疗卒中后 3 个月的功能和生存结局以及 36 小时内的 sICH。
