Large ischemic core defined by visually assessed ASPECTS predicts functional outcomes comparably accurate to automated CT perfusion in the 6-24 h window

Tolga D Dittrich ^1,2,3, Anh Nguyen ^3,4, Peter B Sporns ^3,4

¹Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.
²Department of Neurology and Stroke Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
³Department of Clinical Research, University of Basel, Basel, Switzerland.
⁴Department of Neuroradiology, University Hospital Basel, Basel, Switzerland.
⁵Department of Intensive Care Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
⁶Department of Neurology and Stroke Center, Hirslanden Hospital Zurich, Zurich, Switzerland.
⁷Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
⁸Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, Basel, Switzerland.
⁹Medical Faculty, University of Basel, Basel, Switzerland.
¹⁰Department of Intensive Care Medicine, University Hospital Basel and University of Basel, Basel, Switzerland.
¹¹Emergency Department, University Hospital Basel and University of Basel, Basel, Switzerland.
¹²Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland.
¹³Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland.
¹⁴Department of Radiology and Nuclear Medicine, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
¹⁵Department of Neuroradiology, EOC Neurocenter of Southern Switzerland, Lugano, Switzerland.
¹⁶Department of Neurology and Stroke Center, EOC Neurocenter of Southern Switzerland, Lugano, Switzerland.
¹⁷Rheinfelden Rehabilitation Clinic, Rheinfelden, Switzerland.

⁰Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.

European Stroke Journal +

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October 7, 2024

View abstract on PubMed

Summary

Visually assessed Non-contrast CT Alberta Stroke Program Early CT Scores (ASPECTS) are as effective as automated CT perfusion (aCTP) in predicting outcomes for large vessel occlusion stroke patients. This finding supports using ASPECTS for treatment selection in anterior circulation large vessel occlusion (aLVO).

Area Of Science

Neurology
Radiology
Stroke Medicine

Background

Automated CT perfusion (aCTP) is standard for selecting anterior circulation large vessel occlusion (aLVO) patients for endovascular treatment (EVT).
The predictive accuracy of visually assessed Non-contrast CT Alberta Stroke Program Early CT Scores (ASPECTS) versus aCTP for functional outcomes is not well-established.

Purpose Of The Study

To compare the accuracy of visually assessed ASPECTS and aCTP in predicting favorable functional outcomes in aLVO patients.
To evaluate the association between these imaging modalities and functional outcomes at 3 months post-stroke.

Main Methods

Retrospective analysis of 210 aLVO patients from the Swiss Stroke Registry (2014-2021) treated with EVT or best medical treatment.
ASPECTS assessed visually on non-contrast CT; ischemic core volumes assessed on aCTP.
Logistic regression and ROC curve analysis used to compare predictive accuracy for favorable outcomes (modified Rankin Scale [mRS] 0-2) at 3 months.

Main Results

Visually assessed ASPECTS, but not aCTP core volumes, were significantly associated with favorable functional outcomes (acOR 1.85, P=0.001).
ROC analysis revealed comparable diagnostic accuracy for both modalities (ASPECTS: 0.80 vs. aCTP core: 0.79).

Conclusions

Visually assessed ASPECTS demonstrate comparable, if not superior, accuracy to automated CT perfusion core volumes in predicting functional outcomes for aLVO patients.
ASPECTS remains a valuable tool for guiding treatment decisions in aLVO stroke management.

Keywords:

ASPECTS CT perfusion Ischemic stroke endovascular treatment