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Do All ASPECT Score Regions have the Same Predictive Power for Functional Outcomes?

Dong Hoon Shin¹, Dong-Jin Shin¹, Jung-Ryul Kim²

¹Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association

|December 4, 2019

Summary

Not all Alberta Stroke Program Early CT Score (ASPECTS) regions equally predict outcomes in acute ischemic stroke. Specific cortical regions (M1-M3) showed no prognostic value, unlike other ASPECTS areas.

Keywords:

ASPECT score Cerebral infarction ordinal variable prognosis statistical model

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Area of Science:

Neurology
Radiology
Stroke Medicine

Background:

The Alberta Stroke Program Early CT Score (ASPECTS) is a validated prognostic tool for acute ischemic stroke.
ASPECTS evaluates 10 regions of the cerebral cortex, but the individual prognostic value of each region is not well-defined.

Purpose of the Study:

To determine if all 10 ASPECTS regions possess equal prognostic value in predicting functional outcomes after middle cerebral artery (MCA) territory ischemic stroke.
To identify which specific ASPECTS regions are most crucial for predicting 3-month functional outcomes.

Main Methods:

Retrospective analysis of 350 patients with MCA territory stroke, collecting clinical data, ASPECTS scores, and 3-month modified Rankin Scale (mRS) outcomes.
Application of a proportional odds model to analyze the ordered categorical nature of mRS scores and identify significant predictors.
External validation performed on an independent cohort of 30 patients.

Main Results:

ASPECTS was confirmed as an independent predictor of 3-month functional outcomes.
The M1, M2, and M3 cortical regions were not significant predictors of 3-month mRS in the final model.
Other ASPECTS regions showed significant predictive value, with odds ratios ranging from 2.6 to 3.8. Age was the only significant clinical predictor.

Conclusions:

The prognostic value of ASPECTS regions is not uniform; specific cortical areas (M1-M3) do not contribute to predicting functional outcomes.
A proportional odds model effectively characterized the mRS and identified key predictors, highlighting the differential prognostic importance of ASPECTS regions.