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Updated: Mar 24, 2026
In Vivo Quantitative Assessment of Myocardial Structure, Function, Perfusion and Viability Using Cardiac Micro-computed Tomography
Published on: February 16, 2016
Performance of CT ASPECTS and Collateral Score in Risk Stratification: Can Target Perfusion Profiles Be Predicted
S Dehkharghani1, R Bammer2, M Straka3
1From the Departments of Radiology and Imaging Sciences (S.D., M.B., J.W.A., T.G.) Neurology (S.D., J.W.A., S.R., C.B., F.N.), Emory University Hospital, Atlanta, Georgia Seena.Dehkharghani@Emory.edu.
Insights
Noncontrast CT-ASPECTS and CT angiography collateral scores can predict ischemic core volume in acute ischemic stroke patients. These imaging markers help identify candidates for revascularization therapy.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Endovascular revascularization benefits select acute ischemic stroke patients with large-artery occlusion and small infarct cores.
- Accurate identification of these patients is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To determine thresholds for noncontrast CT-ASPECTS and CT angiography collateral scores that predict ischemic core volume.
- To identify patients with acute ischemic stroke most likely to benefit from revascularization.
Main Methods:
- Fifty-four acute ischemic stroke patients with large-artery occlusion underwent NCCT/CTP.
- CT perfusion (CTP) quantified infarct core volume; a threshold of ≤50 mL was used.
- Noncontrast CT-ASPECTS (NCCT-ASPECTS) and CT angiography (CTA) collateral scores were assessed.
Main Results:
- NCCT-ASPECTS ≥9 with CTA collateral score 3 predicted core volumes ≤50 mL with 100% specificity.
- NCCT-ASPECTS ≤6 predicted core volumes >50 mL with 100% specificity.
- 81% of patients met at least one of these criteria.
Conclusions:
- NCCT-ASPECTS and CTA collateral scores effectively predict infarct core volume in acute ischemic stroke.
- These imaging biomarkers can guide selection for revascularization, potentially reducing the need for CTP in some cases.
- Further CTP imaging may be beneficial for patients not meeting these specific imaging profiles.
Background And Purpose:
Endovascular trials suggest that revascularization benefits a subset of acute ischemic stroke patients with large-artery occlusion and small-core infarct volumes. The objective of our study was to identify thresholds of noncontrast CT-ASPECTS and collateral scores on CT angiography that best predict ischemic core volume thresholds quantified by CT perfusion among patients with acute ischemic stroke.
Materials And Methods:
Fifty-four patients with acute ischemic stroke (<12 hours) and MCA/intracranial ICA occlusion underwent NCCT/CTP during their initial evaluation. CTP analysis was performed on a user-independent platform (RApid processing of PerfusIon and Diffusion), computing core infarct (defined as CBF of <30% normal). A target mismatch profile consisting of infarction core of ≤50 mL was selected to define candidates with acute ischemic stroke likely to benefit from revascularization.
Results:
NCCT-ASPECTS of ≥9 with a CTA collateral score of 3 had 100% specificity for identifying patients with a CBF core volume of ≤50 mL. NCCT-ASPECTS of ≤6 had 100% specificity for identifying patients with a CBF core volume of >50 mL. In our cohort, 44 (81%) patients had an NCCT-ASPECTS of ≥9, a CTA collateral score of 3, or an NCCT-ASPECTS of ≤6.
Conclusions:
Using an NCCT-ASPECTS of ≥9 or a CTA collateral score of 3 best predicts CBF core volume infarct of ≤50 mL, while an NCCT-ASPECTS of ≤6 best predicts a CBF core volume infarct of >50 mL. Together these thresholds suggest that a specific population of patients with acute ischemic stroke not meeting such profiles may benefit most from CTP imaging to determine candidacy for revascularization.
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