From the Department of Radiology (S.M.S., W.B., D.F.K.).
Medical School (A.A.N.), University of Oxford, Oxford, England.
AJNR Am J Neuroradiol. 2020 Nov;41(11):2020-2026. doi: 10.3174/ajnr.A6847. Epub 2020 Oct 15.
Weighting neuroimaging findings based on eloquence can improve the predictive value of ASPECTS, possibly aiding in informed treatment decisions for acute ischemic stroke.
Our aim was to study the contribution of region-specific ASPECTS infarction to acute ischemic stroke outcomes.
We searched MEDLINE and EMBASE for reports on ASPECTS in patients with acute ischemic stroke from 2000 to March 2019.
Two investigators independently reviewed articles and extracted data. Three-month poor functional outcome defined as mRS >2 was the primary end point.
A random-effects meta-analysis was performed to compare the association between infarct and mRS >2 among ASPECTS regions. Subanalyses included the following: laterality of stroke (left/right), imaging technique (NCCT or advanced imaging with DWI, CTP, or CTA), and interventional technique (IV-tPA/conservative management or mechanical thrombectomy).
M6 infarct was most associated with poor functional outcome (OR = 3.26; 95% CI, 2.21-4.80; < .001). Pair-wise comparisons of ASPECTS regions regarding the association between infarct and mRS >2 were not significant, with the exception of M6 versus lentiform (= .009). However, pair-wise comparisons among ASPECTS regions were not significant among subgroup analyses.
Limitations were the heterogeneity of time points, neuroimaging modalities, and interventional techniques; limited studies for inclusion; publication bias among some comparisons; and the retrospective nature of included studies.
Our study indicated an unequal impact of some ASPECTS subregions in predicting outcomes of patients with acute ischemic stroke. Stroke laterality, imaging technique, and interventional technique subgroup analyses showed no differences among ASPECTS regions in predicting outcome. Investigation in larger cohorts is required to assess the association of ASPECTS with acute ischemic stroke outcome.
基于语言能力对神经影像学结果进行加权可以提高 ASPECTS 的预测价值，这可能有助于为急性缺血性脑卒中患者做出更明智的治疗决策。
本研究旨在探讨特定区域 ASPECTS 梗死对急性缺血性脑卒中结局的影响。
我们检索了 2000 年至 2019 年 3 月 MEDLINE 和 EMBASE 数据库中关于急性缺血性脑卒中患者 ASPECTS 的文献。
两名研究者独立地对文章进行了回顾和数据提取。主要终点是 3 个月时 mRS 评分>2 的不良功能结局。
采用随机效应荟萃分析比较了 ASPECTS 区域的梗死与 mRS 评分>2 之间的相关性。亚组分析包括以下内容：卒中的偏侧性（左侧/右侧）、影像学技术（NCCT 或 DWI、CTP 或 CTA 等高级成像技术）以及介入技术（IV-tPA/保守治疗或机械取栓术）。
M6 梗死与不良功能结局的相关性最强（OR=3.26，95%CI：2.21-4.80，<0.001）。关于梗死与 mRS 评分>2 之间相关性的 ASPECTS 区域的两两比较除 M6 与豆状核（=0.009）外均无统计学意义。然而，在亚组分析中，ASPECTS 区域之间的两两比较均无统计学意义。
本研究存在局限性，包括时间点、神经影像学方式和介入技术的异质性、纳入研究数量有限、部分比较存在发表偏倚以及纳入研究的回顾性。
本研究表明，一些 ASPECTS 子区域在预测急性缺血性脑卒中患者结局方面的影响并不均等。卒中的偏侧性、影像学技术和介入技术亚组分析显示，在预测结局方面，ASPECTS 区域之间无差异。需要在更大的队列中进行研究以评估 ASPECTS 与急性缺血性脑卒中结局的相关性。
