Evaluating the Prognosis of Ischemic Stroke Using Low-Dose Multimodal Computed Tomography Parameters in Hyperacute...

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Acute ischemic stroke (AIS) requires rapid and accurate prognostic assessment.
• Early prediction of stroke outcomes aids in treatment decisions and patient management.
• Multimodal computed tomography (CT) offers detailed insights into brain tissue status and perfusion.

Purpose of the Study:

• To evaluate the prognostic value of low-dose multimodal CT in patients with AIS within 6 hours of symptom onset.
• To assess the predictive capability of various CT parameters, including ASPECTS scores and collateral status.

Main Methods:

• A 'one-stop-shop' multimodal CT examination including noncontrast CT (NCCT), low-dose CT perfusion, and CT angiography (CTA) was performed.
• Alberta Stroke Program Early CT Score (ASPECTS) was calculated for NCCT, CTA source images (CTA-SI), and perfusion maps (CBF, CBV, TTP, MTT).
• Regional leptomeningeal collateral (rLMC) score was assessed and dichotomized into good (11-20) and poor (0-10) groups. Poor functional outcome was defined by modified Rankin scale score of 3-6.

Main Results:

• Lower ASPECTS on NCCT, CTA-SI, CBV, CBF, TTP, and MTT, along with poor rLMC, were significantly associated with poor functional outcomes (P < 0.001).
• Multivariate analysis identified CTA-SI-ASPECTS ≤6, poor collaterals, CBV-ASPECTS ≤6, CBF-ASPECTS ≤4, MTT-ASPECTS ≤3, TTP-ASPECTS ≤4, and NCCT-ASPECTS ≤8 as predictors of poor outcome in conservatively treated AIS patients.
• For thrombolysis patients, CTA-SI-ASPECTS ≤6, poor collaterals, and CBV-ASPECTS ≤6 were associated with poor outcomes. The combination of CTA-SI-ASPECTS, collaterals, and CBV-ASPECTS yielded the highest predictive accuracy (AUC, 0.87).

Conclusions:

• Low-dose multimodal CT parameters, particularly ASPECTS scores derived from CTA-SI, CBV, and collateral status, are valuable in predicting AIS prognosis.
• Combining CTA-SI-ASPECTS, collateral status, and CBV-ASPECTS significantly enhances predictive power compared to individual parameters.
• This multimodal approach aids in early risk stratification for AIS patients within the hyperacute treatment window.