Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America.
PLoS One. 2012;7(1):e30352. doi: 10.1371/journal.pone.0030352. Epub 2012 Jan 20.
To improve ischemic stroke outcome prediction using imaging information from a prospective cohort who received admission CT angiography (CTA).
In a prospectively designed study, 649 stroke patients diagnosed with acute ischemic stroke had admission NIH stroke scale scores, noncontrast CT (NCCT), CTA, and 6-month outcome assessed using the modified Rankin scale (mRS) scores. Poor outcome was defined as mRS>2. Strokes were classified as "major" by the (1) Alberta Stroke Program Early CT Score (ASPECTS+) if NCCT ASPECTS was ≤7; (2) Boston Acute Stroke Imaging Scale (BASIS+) if they were ASPECTS+ or CTA showed occlusion of the distal internal carotid, proximal middle cerebral, or basilar arteries; and (3) NIHSS for scores >10.
Of 649 patients, 253 (39.0%) had poor outcomes. NIHSS, BASIS, and age, but not ASPECTS, were independent predictors of outcome. BASIS and NIHSS had similar sensitivities, both superior to ASPECTS (p<0.0001). Combining NIHSS with BASIS was highly predictive: 77.6% (114/147) classified as NIHSS>10/BASIS+ had poor outcomes, versus 21.5% (77/358) with NIHSS≤10/BASIS- (p<0.0001), regardless of treatment. The odds ratios for poor outcome is 12.6 (95% CI: 7.9 to 20.0) in patients who are NIHSS>10/BASIS+ compared to patients who are NIHSS≤10/BASIS-; the odds ratio is 5.4 (95% CI: 3.5 to 8.5) when compared to patients who are only NIHSS>10 or BASIS+.
BASIS and NIHSS are independent outcome predictors. Their combination is stronger than either instrument alone in predicting outcomes. The findings suggest that CTA is a significant clinical tool in routine acute stroke assessment.
利用接受入院 CT 血管造影（CTA）的前瞻性队列的影像学信息来提高缺血性脑卒中的预后预测。
在一项前瞻性设计的研究中，649 名诊断为急性缺血性脑卒中的患者入院时进行 NIH 脑卒中量表评分、非对比 CT（NCCT）、CTA 和 6 个月的改良 Rankin 量表（mRS）评分评估。预后不良定义为 mRS>2。如果 NCCT ASPECTS≤7，则脑卒中被分类为“主要”，即“Alberta 卒中计划早期 CT 评分（ASPECTS+）”；如果是 ASPECTS+或 CTA 显示颈内动脉远端、大脑中动脉近端或基底动脉闭塞，则被分类为“Boston 急性卒中成像量表（BASIS+）”；如果 NIHSS 评分>10，则被分类为 NIHSS。
在 649 名患者中，253 名（39.0%）预后不良。NIHSS、BASIS 和年龄是结局的独立预测因素，但 ASPECTS 不是。BASIS 和 NIHSS 的敏感性相似，均优于 ASPECTS（p<0.0001）。将 NIHSS 与 BASIS 结合具有高度预测性：77.6%（114/147）的 NIHSS>10/BASIS+患者预后不良，而 NIHSS≤10/BASIS-的患者为 21.5%（77/358）（p<0.0001），无论治疗如何。与 NIHSS≤10/BASIS-的患者相比，NIHSS>10/BASIS+的患者预后不良的优势比为 12.6（95%CI：7.9 至 20.0）；与仅 NIHSS>10 或 BASIS+的患者相比，优势比为 5.4（95%CI：3.5 至 8.5）。
BASIS 和 NIHSS 是独立的预后预测因素。两者结合在预测结果方面比单独使用任何一种仪器都强。这些发现表明 CTA 是常规急性卒中评估中的一种重要临床工具。
