Department of Radiology, Changhai Hospital of Shanghai, Navy Medical University (Second Military Medical University), No. 168 Changhai Road, Shanghai, 200433, China.
Department of Cardiac Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Middle Road, Shanghai, 200072, China.
BMC Med Imaging. 2021 Apr 12;21(1):67. doi: 10.1186/s12880-021-00593-5.
ASPECTS scoring method varies, but which one is most suitable for predicting the prognosis still unclear. We aimed to evaluate the diagnostic performance of Automated (Auto)-, noncontrast CT (NCCT)- and CT perfusion (CTP) -ASPECTS for early ischemic changes (EICs) in acute ischemic stroke patients with large vessel occlusion (LVO) and to explore which scoring method is most suitable for predicting the clinical outcome.
Eighty-one patients with anterior circulation LVO were retrospectively enrolled and grouped as having a good (0-2) or poor (3-6) clinical outcome using a 90-day modified Rankin Scale score. Clinical characteristics and perfusion parameters were compared between the patients with good and poor outcomes. Differences in scores obtained with the three scoring methods were assessed. Diagnosis performance and receiver operating characteristic (ROC) curves were used to evaluate the value of the three ordinal or dichotomized ASPECTS methods for predicting the clinical outcome.
Sixty-three patients were finally included, with 36 (57.1%) patients having good clinical outcome. Significant differences were observed in the ordinal or dichotomized Auto-, NCCT- and CTP-ASPECTS between the patients with good and poor clinical outcomes (all p < 0.01). The areas under the curves (AUCs) of the ordinal and dichotomized CTP-ASPECTS were higher than that of the other two methods (all p < 0.01), but the AUCs of the Auto-ASPECTS was similar to that of the NCCT-ASPECTS (p > 0.05).
The CTP-ASPECTS is superior to the Auto- and NCCT-ASPECTS in detecting EICs in LVO. CTP-ASPECTS with a cutoff value of 6 is a good predictor of the clinical outcome at 90-day follow-up.
ASPECTS 评分方法多种多样，但哪种方法最适合预测预后尚不清楚。我们旨在评估自动（Auto）、非对比 CT（NCCT）和 CT 灌注（CTP）-ASPECTS 在大动脉闭塞（LVO）急性缺血性脑卒中患者早期缺血性改变（EICs）中的诊断性能，并探讨哪种评分方法最适合预测临床结局。
回顾性纳入 81 例前循环 LVO 患者，根据 90 天改良 Rankin 量表评分将其分为预后良好（0-2 分）和预后不良（3-6 分）两组。比较两组患者的临床特征和灌注参数。评估三种评分方法的评分差异。采用诊断性能和受试者工作特征（ROC）曲线评估三种有序或二分类 ASPECTS 方法预测临床结局的价值。
最终纳入 63 例患者，其中 36 例（57.1%）患者临床结局良好。预后良好和预后不良患者的有序或二分类 Auto、NCCT 和 CTP-ASPECTS 差异均有统计学意义（均 P<0.01）。有序和二分类 CTP-ASPECTS 的曲线下面积（AUC）均高于其他两种方法（均 P<0.01），但 Auto-ASPECTS 的 AUC 与 NCCT-ASPECTS 相似（P>0.05）。
在检测 LVO 中的 EICs 方面，CTP-ASPECTS 优于 Auto-和 NCCT-ASPECTS。CTP-ASPECTS 截断值为 6 时，是 90 天随访时预测临床结局的良好指标。
