Aoki Junya, Tateishi Yohei, Cummings Christopher L, Cheng-Ching Esteban, Ruggieri Paul, Hussain Muhammad Shazam, Uchino Ken
Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
J Stroke Cerebrovasc Dis. 2014 Nov-Dec;23(10):2845-2850. doi: 10.1016/j.jstrokecerebrovasdis.2014.07.015. Epub 2014 Oct 16.
We investigated whether a computed tomography (CT)-based score could predict a large infarct (≥ 80 mL) on early diffusion-weighted magnetic resonance imaging (DWI).
Acute stroke patients considered for endovascular therapy within 8 hours of the onset of symptoms were included. The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was determined on noncontrast CT and computed tomography angiography source images (CTA-SI). Limited collateral flow was defined as less than 50% collateral filling on CTA-SI.
Fifty-six patients were analyzed. National Institutes of Health Stroke Scale score was 20 (15-24) in the large infarct group and 16 (11-20) in the small infarct group (P = .049). ASPECTS on noncontrast CT and CTA-SI was 5 (3-8) and 3 (2-6) in the large infarct group and 9 (8-10) and 8 (7-9) in the small infarct group (both P < .001), respectively. Limited collateral flow was frequent in the large infarct group than in the small infarct group (92% vs. 11%, P < .001). Multivariate analysis found that CTA-SI ASPECTS less than or equal to 5 (odds ratio [OR], 40.55; 95% confidence interval [CI], 1.10-1493.44; P = .044) and limited collateral flow (OR, 114.64; 95% CI, 1.93-6812.79; P = .023) were associated with a large infarct. Absence of ASPECTS less than or equal to 5 and limited collateral flow on CTA-SI predicted absence of a large infarct with a sensitivity of .89, specificity of 1.00, positive predictive value of 1.00, and negative predictive value of .71.
Assessment of ASPECTS and collateral flow on CTA-SI may be able to exclude a patient with large infarct on early DWI.
我们研究了基于计算机断层扫描（CT）的评分是否能够在早期弥散加权磁共振成像（DWI）上预测大面积梗死（≥80 mL）。
纳入症状发作8小时内考虑进行血管内治疗的急性卒中患者。在非增强CT和计算机断层扫描血管造影源图像（CTA-SI）上确定阿尔伯塔卒中项目早期CT评分（ASPECTS）。有限侧支血流定义为CTA-SI上侧支充盈小于50%。
分析了56例患者。大面积梗死组美国国立卫生研究院卒中量表评分为20（15 - 24），小面积梗死组为16（11 - 20）（P = 0.049）。大面积梗死组非增强CT和CTA-SI上的ASPECTS分别为5（3 - 8）和3（2 - 6），小面积梗死组分别为9（8 - 10）和8（7 - 9）（均P < 0.001）。大面积梗死组有限侧支血流比小面积梗死组更常见（92%对11%，P < 0.001）。多变量分析发现，CTA-SI上的ASPECTS小于或等于5（比值比[OR]，40.55；95%置信区间[CI]，1.10 - 1493.44；P = 0.044）和有限侧支血流（OR，114.64；95% CI，1.93 - 6812.79；P = 0.023）与大面积梗死相关。CTA-SI上不存在ASPECTS小于或等于5以及有限侧支血流预测不存在大面积梗死，敏感性为0.89，特异性为1.00，阳性预测值为1.00，阴性预测值为0.71。
评估CTA-SI上的ASPECTS和侧支血流可能能够在早期DWI上排除大面积梗死患者。
