Department of Radiology (S.V., J.V., B.C., V.K., T.T., A.V.), University of Cincinnati Medical Center, OH.
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, OH (B.Z.).
Stroke. 2021 Jan;52(2):498-504. doi: 10.1161/STROKEAHA.120.030353. Epub 2021 Jan 7.
The Alberta Stroke Program Early Computed Tomography (CT) Score (ASPECTS) and CT perfusion (CTP) are commonly used to predict the ischemic core in acute ischemic strokes. CT angiography source images (CTA-SI) can also provide additional information to identify the extent of ischemia. Our objective was to investigate the correlation of noncontrast CT (NCCT) ASPECTS and CTA-SI ASPECTS with CTP core volumes.
We utilized a single institutional, retrospective registry of consecutive patients with acute ischemic stroke with large vessel occlusion between May 2016 and May 2018. We graded ASPECTS both on baseline NCCT and CTA-SI and measured CTP core using automated RAPID software (cerebral blood flow <30%). We used Spearman's correlation coefficients to evaluate the correlation between continuous variables.
A total of 52 patients fit the inclusion criteria of large vessel occlusion in 6 to 24 hours and baseline imaging work up of NCCT, CTA, and CTP. The median age was 63 (interquartile range=53.5-75) and 38.46% were female. The median NCCT ASPECTS was 7 (interquartile range=6-9), CTA-SI ASPECTS was 5 (interquartile range=4-7), and CTP core was 14.5 mL (interquartile range=0-46 mL). There was a moderate correlation between NCCT ASPECTS and CTP core (r=-0.55, <0.0001) and between CTA-SI ASPECTS and CTP core (r=-0.50, =0.0002). The optimal NCCT ASPECTS cutoff score to detect CTP core ≤70 mL was ≥6 (sensitivity, 0.84; specificity, 0.57; positive predictive value, 0.93; negative predictive value, 0.36) and the optimal CTA-SI ASPECTS was ≥5 (sensitivity, 0.76; specificity, 0.71; positive predictive value, 0.94; negative predictive value, 0.31).
There was a moderate correlation between NCCT and CTA-SI ASPECTS in predicting CTP defined ischemic core in delayed time windows. Further studies are needed to determine if NCCT and CTA imaging could be used for image-based patient selection when CTP imaging is not available.
艾伯塔省卒中计划早期计算机断层扫描（CT）评分（ASPECTS）和 CT 灌注（CTP）常用于预测急性缺血性卒中的缺血核心。CT 血管造影源图像（CTA-SI）也可以提供额外的信息来识别缺血程度。我们的目的是研究非对比 CT（NCCT）ASPECTS 和 CTA-SI ASPECTS 与 CTP 核心体积之间的相关性。
我们利用 2016 年 5 月至 2018 年 5 月期间连续接受急性大血管闭塞性缺血性卒中治疗的单机构回顾性登记处。我们在基线 NCCT 和 CTA-SI 上分级 ASPECTS，并使用自动 RAPID 软件测量 CTP 核心（脑血流<30%）。我们使用 Spearman 相关系数评估连续变量之间的相关性。
共有 52 例患者符合大血管闭塞 6 至 24 小时内的纳入标准，以及 NCCT、CTA 和 CTP 的基线影像学检查。中位年龄为 63 岁（四分位距=53.5-75 岁），38.46%为女性。NCCT ASPECTS 的中位数为 7（四分位距=6-9），CTA-SI ASPECTS 的中位数为 5（四分位距=4-7），CTP 核心为 14.5mL（四分位距=0-46mL）。NCCT ASPECTS 与 CTP 核心之间存在中度相关性（r=-0.55，<0.0001），CTA-SI ASPECTS 与 CTP 核心之间存在中度相关性（r=-0.50，=0.0002）。检测 CTP 核心≤70mL 的最佳 NCCT ASPECTS 截断值为≥6（敏感性，0.84；特异性，0.57；阳性预测值，0.93；阴性预测值，0.36），最佳 CTA-SI ASPECTS 为≥5（敏感性，0.76；特异性，0.71；阳性预测值，0.94；阴性预测值，0.31）。
在预测延迟时间窗内 CTP 定义的缺血核心时，NCCT 和 CTA-SI ASPECTS 之间存在中度相关性。需要进一步研究确定当 CTP 成像不可用时，NCCT 和 CTA 成像是否可用于基于图像的患者选择。
