BACKGROUND AND PURPOSE: The semiquantitative noncontrast CT Alberta Stroke Program Early CT Score (ASPECTS) and RAPID automated computed tomography (CT) perfusion (CTP) ischemic core volumetric measurements have been used to quantify infarct extent. We aim to determine the correlation between ASPECTS and CTP ischemic core, evaluate the variability of core volumes within ASPECTS strata, and assess the strength of their association with clinical outcomes. METHODS: Review of a prospective, single-center database of consecutive thrombectomies of middle cerebral or intracranial internal carotid artery occlusions with pretreatment CTP between September 2010 and September 2015. CTP was processed with RAPID software to identify ischemic core (relative cerebral blood flow<30% of normal tissue). RESULTS: Three hundred and thirty-two patients fulfilled inclusion criteria. Median age was 66 years (55-75), median ASPECTS was 8 (7-9), whereas median CTP ischemic core was 11 cc (2-27). Median time from last normal to groin puncture was 5.8 hours (3.9-8.8), and 90-day modified Rankin scale score 0 to 2 was observed in 54%. The correlation between CTP ischemic core and ASPECTS was fair (R=-0.36; P<0.01). Twenty-six patients (8%) had ASPECTS <6 and CTP core ≤50 cc (37% had modified Rankin scale score 0-2, whereas 29% were deceased at 90 days). Conversely, 27 patients (8%) had CTP core >50 cc and ASPECTS ≥6 (29% had modified Rankin scale 0-2, whereas 21% were deceased at 90 days). Moderate correlations between ASPECTS and final infarct volume (R=-0.42; P<0.01) and between CTP ischemic core and final infarct volume (R=0.50; P<0.01) were observed; coefficients were not significantly influenced by the time from stroke onset to presentation. Multivariable regression indicated ASPECTS ≥6 (odds ratio 4.10; 95% confidence interval, 1.47-11.46; P=0.01) and CTP core ≤50 cc (odds ratio 3.86; 95% confidence interval, 1.22-12.15; P=0.02) independently and comparably predictive of good outcome. CONCLUSIONS: There is wide variability of CTP-derived core volumes within ASPECTS strata. Patient selection may be affected by the imaging selection method.
BACKGROUND AND PURPOSE: The semiquantitative noncontrast CT Alberta Stroke Program Early CT Score (ASPECTS) and RAPID automated computed tomography (CT) perfusion (CTP) ischemic core volumetric measurements have been used to quantify infarct extent. We aim to determine the correlation between ASPECTS and CTPischemic core, evaluate the variability of core volumes within ASPECTS strata, and assess the strength of their association with clinical outcomes. METHODS: Review of a prospective, single-center database of consecutive thrombectomies of middle cerebral or intracranial internal carotid artery occlusions with pretreatment CTP between September 2010 and September 2015. CTP was processed with RAPID software to identify ischemic core (relative cerebral blood flow<30% of normal tissue). RESULTS: Three hundred and thirty-two patients fulfilled inclusion criteria. Median age was 66 years (55-75), median ASPECTS was 8 (7-9), whereas median CTPischemic core was 11 cc (2-27). Median time from last normal to groin puncture was 5.8 hours (3.9-8.8), and 90-day modified Rankin scale score 0 to 2 was observed in 54%. The correlation between CTPischemic core and ASPECTS was fair (R=-0.36; P<0.01). Twenty-six patients (8%) had ASPECTS <6 and CTP core ≤50 cc (37% had modified Rankin scale score 0-2, whereas 29% were deceased at 90 days). Conversely, 27 patients (8%) had CTP core >50 cc and ASPECTS ≥6 (29% had modified Rankin scale 0-2, whereas 21% were deceased at 90 days). Moderate correlations between ASPECTS and final infarct volume (R=-0.42; P<0.01) and between CTPischemic core and final infarct volume (R=0.50; P<0.01) were observed; coefficients were not significantly influenced by the time from stroke onset to presentation. Multivariable regression indicated ASPECTS ≥6 (odds ratio 4.10; 95% confidence interval, 1.47-11.46; P=0.01) and CTP core ≤50 cc (odds ratio 3.86; 95% confidence interval, 1.22-12.15; P=0.02) independently and comparably predictive of good outcome. CONCLUSIONS: There is wide variability of CTP-derived core volumes within ASPECTS strata. Patient selection may be affected by the imaging selection method.
Authors: James E Siegler; Steven R Messé; Heidi Sucharew; Scott E Kasner; Tapan Mehta; Niraj Arora; Amy K Starosciak; Felipe De Los Rios La Rosa; Natasha R Barnhill; Akshitkumar M Mistry; Kishan Patel; Salman Assad; Amjad Tarboosh; Katarina Dakay; Jeff Wagner; Alicia Bennett; Bharathi Jagadeesan; Christopher Streib; Stewart A Weber; Rohan Chitale; John J Volpi; Stephan A Mayer; Shadi Yaghi; Mahesh V Jayaraman; Pooja Khatri; Eva A Mistry Journal: J Neuroimaging Date: 2019-11-24 Impact factor: 2.486
Authors: Thoralf Thamm; Jia Guo; Jarrett Rosenberg; Tie Liang; Michael P Marks; Soren Christensen; Huy M Do; Stephanie M Kemp; Emma Adair; Irina Eyngorn; Michael Mlynash; Tudor G Jovin; Bart P Keogh; Hui J Chen; Maarten G Lansberg; Gregory W Albers; Greg Zaharchuk Journal: Stroke Date: 2019-10-17 Impact factor: 7.914
Authors: Anderson Chun On Tsang; Stephanie Lenck; Christopher Hilditch; Patrick Nicholson; Waleed Brinjikji; Timo Krings; Vitor M Pereira; Frank L Silver; Joanna D Schaafsma Journal: Clin Neuroradiol Date: 2018-11-23 Impact factor: 3.649
Authors: Jelle Demeestere; Lauranne Scheldeman; Sandra A Cornelissen; Sam Heye; Anke Wouters; Patrick Dupont; Sören Christensen; Michael Mlynash; Gregory W Albers; Maarten Lansberg; Robin Lemmens Journal: Stroke Date: 2018-10 Impact factor: 7.914
Authors: A Z Copelan; E R Smith; G T Drocton; K H Narsinh; D Murph; R S Khangura; Z J Hartley; A A Abla; W P Dillon; C F Dowd; R T Higashida; V V Halbach; S W Hetts; D L Cooke; K Keenan; J Nelson; D Mccoy; M Ciano; M R Amans Journal: AJNR Am J Neuroradiol Date: 2020-11-19 Impact factor: 3.825
Authors: C C McDougall; L Chan; S Sachan; J Guo; R G Sah; B K Menon; A M Demchuk; M D Hill; N D Forkert; C D d'Esterre; P A Barber Journal: AJNR Am J Neuroradiol Date: 2020-10-01 Impact factor: 3.825
Authors: James E Siegler; Andrew Olsen; Jon Rosenberg; Daniel Cristancho; Johannes Pulst-Korenberg; Lindsay Raab; John H Woo; Steven R Messé Journal: Clin Neurol Neurosurg Date: 2020-03-19 Impact factor: 1.876
Authors: S Nannoni; F Ricciardi; D Strambo; G Sirimarco; M Wintermark; V Dunet; P Michel Journal: AJNR Am J Neuroradiol Date: 2021-01-28 Impact factor: 3.825