Diagnostic and Prognostic Impact of pc-ASPECTS Applied to Perfusion CT in the Basilar Artery International Cooperation Study

J Neuroimaging. May-Jun 2015;25(3):384-9. doi: 10.1111/jon.12130. Epub 2014 Jun 18.

Abstract

Background and purpose: The posterior circulation Acute Stroke Prognosis Early CT Score (pc-APECTS) applied to CT angiography source images (CTA-SI) predicts the functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS). We assessed the diagnostic and prognostic impact of pc-ASPECTS applied to perfusion CT (CTP) in the BASICS registry population.

Methods: We applied pc-ASPECTS to CTA-SI and cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) parameter maps of BASICS patients with CTA and CTP studies performed. Hypoattenuation on CTA-SI, relative reduction in CBV or CBF, or relative increase in MTT were rated as abnormal.

Results: CTA and CTP were available in 27/592 BASICS patients (4.6%). The proportion of patients with any perfusion abnormality was highest for MTT (93%; 95% confidence interval [CI], 76%-99%), compared with 78% (58%-91%) for CTA-SI and CBF, and 46% (27%-67%) for CBV (P < .001). All 3 patients with a CBV pc-ASPECTS < 8 compared to 6/23 patients with a CBV pc-ASPECTS ≥ 8 had died at 1 month (RR 3.8; 95% CI, 1.9-7.6).

Conclusion: CTP was performed in a minority of the BASICS registry population. Perfusion disturbances in the posterior circulation were most pronounced on MTT parameter maps. CBV pc-ASPECTS < 8 may indicate patients with high case fatality.

Keywords: CT perfusion; basilar artery occlusion; pc-ASPECTS.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Distribution
  • Aged
  • Brain Infarction / diagnostic imaging*
  • Brain Infarction / mortality*
  • Cerebral Angiography / statistics & numerical data*
  • Female
  • Humans
  • Internationality
  • Male
  • Middle Aged
  • Prevalence
  • Prognosis
  • Registries*
  • Reproducibility of Results
  • Risk Factors
  • Sensitivity and Specificity
  • Sex Distribution
  • Survival Rate
  • Tomography, X-Ray Computed / statistics & numerical data*
  • Vertebrobasilar Insufficiency