Ghandehari Kavian, Rezvani Mohammad Reza, Shakeri Mohammad Taghi, Mohammadifard Mahdi, Ehsanbakhsh Alireza, Mohammadifard Mahyar, Mirgholami Alireza, Boostani Reza, Ghandehari Kosar, Izadi-Mood Zahra
Professor of Cerebrovascular Disease, Neuroscience Research Center, Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
J Res Med Sci. 2011 Oct;16(10):1326-31.
The Alberta Stroke Program Early Computerized Tomography Score (ASPECTS) was used to detect significant early ischemic changes on brain CT of acute stroke patients. We designed the modified ASPECTS and compared it to the above system based on the inter-rater reliability.
A cross-sectional validation study was conducted based on the inter-rater reliability. The CT images were chosen from the stroke data bank of Ghaem hospital, Mashhad in 2010. The inclusion criteria were the presence of middle cerebral artery territory infarction and performance of CT within 6 hours after stroke onset. Axial CT scans were performed on a third-generation CT scanner (Siemens, ARTX, Germany). Section thickness above posterior fossa was 10 mm (130 kV, 150 mAs). Films were made at window level of 35 HU. The brain CTs were scored by four independent radiologists based on the ASPECTS and modified ASPECTS. The readers were blind to clinical information except symptom side. Cochrane Q and Kappa tests served for statistical analysis.
24 CT scans were available and of sufficient quality. Difference in distribution of dichotomized ≤7 and >7 ASPECT scores between four raters was significant (Q=13.071, df=3, p=0.04). Distribution of dichotomized <6 and ≥6 scores based on modified ASPECT system between 4 raters was not significantly different (Q=6.349, df=3, p=0.096).
Modified ASPECT method is more reliable than ASPECTS in detecting major early ischemic changes in stroke patients candidated to tPA thrombolysis.
阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）用于检测急性卒中患者脑部CT上显著的早期缺血性改变。我们设计了改良的ASPECTS，并基于评分者间信度将其与上述系统进行比较。
基于评分者间信度进行了一项横断面验证研究。CT图像选自2010年马什哈德加姆医院的卒中数据库。纳入标准为存在大脑中动脉区域梗死且在卒中发作后6小时内进行CT检查。在第三代CT扫描仪（德国西门子ARTX）上进行轴向CT扫描。后颅窝上方的切片厚度为10毫米（130千伏，150毫安秒）。在窗宽35HU下制作胶片。四位独立的放射科医生根据ASPECTS和改良的ASPECTS对脑部CT进行评分。除症状侧外，阅片者对临床信息不知情。采用Cochrane Q检验和Kappa检验进行统计分析。
有24份CT扫描可用且质量足够。四位评分者之间二分法ASPECT评分≤7和>7的分布差异显著（Q = 13.071，自由度 = 3，p = 0.04）。基于改良ASPECT系统的四位评分者之间二分法<6和≥6评分的分布无显著差异（Q = 6.349，自由度 = 3，p = 0.096）。
在检测适合tPA溶栓的卒中患者的主要早期缺血性改变方面，改良的ASPECT方法比ASPECTS更可靠。
