Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea.
J Stroke. 2016 Jan;18(1):80-6. doi: 10.5853/jos.2015.01298. Epub 2015 Oct 15.
We developed a novel method named Gray-matter Volume Estimate Score (GRAVES), measuring early ischemic changes on Computed Tomography (CT) semi-automatically by computer software. This study aimed to compare GRAVES and Alberta Stroke Program Early CT Score (ASPECTS) with regards to outcome prediction and inter-rater agreement.
This was a retrospective cohort study. Among consecutive patients with ischemic stroke in the anterior circulation who received intra-arterial therapy (IAT), those with a readable pretreatment CT were included. Two stroke neurologists independently measured both the GRAVES and ASPECTS. GRAVES was defined as the percentage of estimated hypodense lesion in the gray matter of the ipsilateral hemisphere. Spearman correlation analysis, receiver operating characteristic (ROC) comparison test, and intra-class correlation coefficient (ICC) comparison tests were performed between GRAVES and ASPECTS.
Ninety-four subjects (age: 68.7±10.3; male: 54 [54.9%]) were enrolled. The mean GRAVES was 9.0±8.9 and the median ASPECTS was 8 (interquartile range, 6-9). Correlation between ASPECTS and GRAVES was good (Spearman's rank correlation coefficient, 0.642; P<0.001). ROC comparison analysis showed that the predictive value of GRAVES for favorable outcome was not significantly different from that of ASPECTS (area under curve, 0.765 vs. 0.717; P=0.308). ICC comparison analysis revealed that inter-rater agreement of GRAVES was significantly better than that of ASPECTS (0.978 vs. 0.895; P<0.001).
GRAVES had a good correlation with ASPECTS. GRAVES was as good as ASPECTS in predicting a favorable clinical outcome, but was better than ASPECTS regarding inter-rater agreement. GRAVES may be used to predict the outcome of IAT.
我们开发了一种新的方法，名为灰质容积估计评分（GRAVES），通过计算机软件半自动测量计算机断层扫描（CT）上的早期缺血性改变。本研究旨在比较 GRAVES 和阿尔伯塔卒中项目早期 CT 评分（ASPECTS）在预后预测和观察者间一致性方面的表现。
这是一项回顾性队列研究。在接受动脉内治疗（IAT）的前循环缺血性卒中患者中，纳入了可读取治疗前 CT 的患者。两位卒中神经科医生独立测量 GRAVES 和 ASPECTS。GRAVES 定义为对侧半球灰质内估计的低密度病变的百分比。对 GRAVES 和 ASPECTS 进行 Spearman 相关分析、受试者工作特征（ROC）比较检验和组内相关系数（ICC）比较检验。
共纳入 94 例患者（年龄：68.7±10.3；男性：54 例[54.9%]）。平均 GRAVES 为 9.0±8.9，中位数 ASPECTS 为 8（四分位距，6-9）。ASPECTS 与 GRAVES 之间相关性良好（Spearman 等级相关系数，0.642；P<0.001）。ROC 比较分析显示，GRAVES 对良好结局的预测价值与 ASPECTS 无显著差异（曲线下面积，0.765 比 0.717；P=0.308）。ICC 比较分析显示，GRAVES 的观察者间一致性明显优于 ASPECTS（0.978 比 0.895；P<0.001）。
GRAVES 与 ASPECTS 相关性良好。GRAVES 在预测临床结局方面与 ASPECTS 相当，但在观察者间一致性方面优于 ASPECTS。GRAVES 可用于预测 IAT 的结局。
