Stroke Unit-Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy.
Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Acta Neurol Belg. 2023 Aug;123(4):1405-1411. doi: 10.1007/s13760-023-02239-5. Epub 2023 Apr 8.
The routinely used computed tomography (CT)-based workup in the setting of acute ischemic stroke (AIS) includes non-contrast brain CT, CT angiography (CTA), and CT perfusion. Several CT, CTA, CTP-based radiological biomarkers of hemorrhagic transformation (HT) were reported.
To assess the predictive value of the combined multimodal CT parameters for HT after AIS and proposal of predictive scoring scale.
The source images of the NCCT, CTA and CTP of 282 AIS patients involving the anterior circulation (HT = 91, non-HT = 191) were retrospectively reviewed and the following biomarkers were recorded and analyzed: Early subtle ischemic signs, hyperdense middle cerebral artery sign (HMCAS) and Alberta Stroke Program Early CT Score (ASPECTS) < 7 in NCCT, large-vessel occlusion (LVO), clot burden score (CBS) < 6, large-vessel occlusion, poor collateral score (CS) and Tmax > 6 s ≥ 56.5 ml. A scoring system to predict HT based on these biomarkers was developed. Each biomarker counts for a single point with the total score ranging from 0 to 7.
All the aforementioned multimodal CT biomarkers and the selected cut offs were significantly associated with higher HT risk. The calculated scores were statistically significant different between the HT and the non-HT groups with AUC 0.761 (95% CI 0.703-0.819, P < 0.0000001). Rates of HT were approximately five times higher in patients with score ≥ 3.
Multimodal CT-based scoring system may provide highly reliable predictive model of hemorrhagic transformation in acute ischemic stroke.
急性缺血性脑卒中（AIS）常规使用的基于计算机断层扫描（CT）的检查包括非增强脑 CT、CT 血管造影（CTA）和 CT 灌注。已经报道了几种基于 CT、CTA 和 CTP 的出血转化（HT）的放射学生物标志物。
评估 AIS 后多模态 CT 参数联合对 HT 的预测价值，并提出预测评分量表。
回顾性分析 282 例涉及前循环的 AIS 患者的 NCCT、CTA 和 CTP 原始图像（HT=91，非-HT=191），记录并分析以下生物标志物：早期轻微缺血征象、高密度大脑中动脉征（HMCAS）和 NCCT 中 Alberta 卒中计划早期 CT 评分（ASPECTS）<7、大血管闭塞（LVO）、血栓负荷评分（CBS）<6、大血管闭塞、差侧支评分（CS）和 Tmax>6 s≥56.5 ml。根据这些生物标志物开发了一种预测 HT 的评分系统。每个生物标志物计 1 分，总分 0 至 7 分。
所有上述多模态 CT 生物标志物和选定的截止值均与更高的 HT 风险显著相关。计算得出的分数在 HT 组和非-HT 组之间有统计学差异，AUC 为 0.761（95%CI 0.703-0.819，P<0.0000001）。评分≥3 的患者发生 HT 的比例约为 5 倍。
基于多模态 CT 的评分系统可为急性缺血性脑卒中的出血转化提供高度可靠的预测模型。
