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AJNR - American Journal of Neuroradiology

Publication Preview: Published October 5, 2007

American Journal of Neuroradiology 2007;28:1975.

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American Journal of Neuroradiology
DOI 10.3174/ajnr.A0689

BRAIN

Alberta Stroke Program Early CT Scoring of CT Perfusion in Early Stroke Visualization and Assessment

R.I. Aviv, J. Mandelcorn, S. Chakraborty, D. Gladstone, S. Malham, G. Tomlinson, A.J. Fox and S. Symons

From the Division of Neuroradiology (R.I.A., J.M., S.C., S.M., A.J.F., S.S.), Neurology and Regional Stroke Center (D.G.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; and Department of Biostatistics (G.T.), University of Toronto, Toronto, Ontario, Canada.

Please address correspondence to: R. Aviv, MD, Division of Neuroradiology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto M4N 3M5, Ontario, Canada; e-mail: richardaviv{at}lineone.net

BACKGROUND AND PURPOSE: Qualitative CT perfusion (CTP) assessment by using the Alberta Stroke Program Early CT Score (ASPECTS) allows rapid calculation of infarct extent for middle cerebral artery infarcts. Published thresholds exist for noncontrast CT (NCCT) ASPECTS, which may distinguish outcome/complication risk, but early ischemic signs are difficult to detect. We hypothesized that different ASPECTS thresholds exist for CTP parameters versus NCCT and that these may be superior at predicting clinical and radiologic outcome in the acute setting.

MATERIALS AND METHODS: Thirty-six baseline acute stroke NCCT and CTP studies within 3 hours of symptoms were blindly reviewed by 3 neuroradiologists, and ASPECTS were assigned. Treatment response was defined as major neurologic improvement when a 8-point National Institutes of Health Stroke Scale improvement at 24 hours occurred. Follow-up NCCT ASPECTS and 90-day modified Rankin score (mRS) were radiologic and clinical reference standards. Receiver operating characteristic curves derived optimal thresholds for outcome.

RESULTS: Cerebral blood volume and NCCT ASPECTS had similar radiologic correlations (0.6 and 0.5, respectively) and best predicted infarct size in the absence of major neurologic improvement. A NCCT ASPECT threshold of 7 and a cerebral blood volume threshold of 8 discriminated patients with poor follow-up scans (P < .0002 and P = .0001) and mRS 2 (P = .001 and P < .001). Only cerebral blood volume predicted major neurologic improvement (P = .02). Interobserver agreement was substantial (intraclass correlation coefficient, 0.69). Cerebral blood volume ASPECTS sensitivity, specificity, positive predictive value, and negative predictive value for clinical outcome were 60%, 100%, 100%, and 45%, respectively. No patients with cerebral blood volume ASPECTS <8 achieved good clinical outcome.

CONCLUSION: Cerebral blood volume ASPECTS is equivalent to NCCT for predicting radiologic outcome but may have an additional benefit in predicting patients with major neurologic improvement.

This article has been cited by other articles:

				K. Lin, O. Rapalino, M. Law, J.S. Babb, K.A. Siller, and B.K. Pramanik Accuracy of the Alberta Stroke Program Early CT Score during the First 3 Hours of Middle Cerebral Artery Stroke: Comparison of Noncontrast CT, CT Angiography Source Images, and CT Perfusion AJNR Am. J. Neuroradiol., May 1, 2008; 29(5): 931 - 936. [Abstract] [Full Text] [PDF]