[Combined application of multi-parameter semiquantitative Alberta stroke program early CT score to assess infarction severity in acute ischemic stroke].

To explore the significance of multi-parameter semiquantitative Alberta Stroke Program Early CT Score (ASPECTS) in detecting core infarction in acute ischemic stroke (AIS) patients. Twenty-one consecutive AIS patients from Beijing Hospital were retrospectively reviewed in this study from August 2016 to August 2017. All the patients presented within 6 hours since symptom onset.All the patients underwent one-stop dynamic whole brain 4D CTA-CTP scan before treatments (intravenous thrombolysis, mechanical thrombectomy, or other endovascular recanalization). MRI scan was performed in all patients 3 to 7 days after initial administration. Multi-parameter ASPECTS was calculated on the affected hemisphere regarding noncontrast CT (NCCT) map, cerebral blood flow (CBF) map, cerebral blood volume (CBV) map, mean transit time (MTT) map and MRI-DWI map by subtracting 1 point from 10 for any abnormalities visually detected. The evaluative consistency and diagnostic efficiency were analyzed by χ(2) test, identity test, and ' coefficient of concordance using IBM SPSS statistics 22.0 software. Compared with DWI-ASPECTS or follow-up NCCT-ASPECTS, CBV-ASPECTS had the best performance on both the identity test ( coefficient κ=0.74)and coefficient of concordance (τ=0.70). All the values of sensitivity (77.8%), specificity (95.5%), positive likelihood ratio (17.27) and AUC(0.87)were the highest in CBV-ASPECTS, followed by dMTT-ASPECTS. Meanwhile, the misdiagnosis rate (4.5%), missed diagnosis rate (22.2%) and negative likelihood ratio were the lowest in CBV-ASPECTS, followed by dMTT-ASPECTS. dMTT-ASPECTS had the same specificity(95.5%) as CBV-ASPECTS did and it could reveal the infarction in the areas where CBV map showed normal. NCCT-ASPECTS had the lowest sensitivity (64.7%) and highest missed diagnosis rate (35.3%). The misdiagnosis rate of CBF-ASPECTS was the highest (25.2%) and AUC was the lowest (0.76). Multi-parameter semiquantitative ASPECTS may predict the infarction accurately in AIS patients. Compared with the single parameter of NCCT-ASPECTS, this new method may have better detectability and diagnostic performance.