Diagnostic accuracy of using Alberta Stroke Program Early Computed Tomography Score on CT perfusion map to predict a target mismatch in patients with acute ischemic stroke

Yue Chu; Guang-Chen Shen; Gao Ma; Xiao-Quan Xu; Shan-Shan Lu; Lei Jiang; Sheng Liu; Hai-Bin Shi; Fei-Yun Wu

doi:10.1007/s00234-021-02892-8

Diagnostic accuracy of using Alberta Stroke Program Early Computed Tomography Score on CT perfusion map to predict a target mismatch in patients with acute ischemic stroke

Neuroradiology. 2022 Jul;64(7):1321-1330. doi: 10.1007/s00234-021-02892-8. Epub 2022 Jan 3.

Authors

Yue Chu¹, Guang-Chen Shen¹, Gao Ma¹, Xiao-Quan Xu², Shan-Shan Lu¹, Lei Jiang³, Sheng Liu⁴, Hai-Bin Shi⁴, Fei-Yun Wu⁵

Affiliations

¹ Department of Radiology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China.
² Department of Radiology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China. xiaoquanxu_1987@163.com.
³ Department of Emergency, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
⁴ Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
⁵ Department of Radiology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China. wfy_njmu@163.com.

PMID: 34981174
DOI: 10.1007/s00234-021-02892-8

Abstract

Purpose: To assess the diagnostic accuracy of using Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on CT perfusion (CTP) map to predict a volumetric target mismatch in patients with acute ischemic stroke (AIS).

Methods: Three-hundred and seven AIS patients with an onset time within 24h or unclear onset time who underwent CTP evaluation for large vessel occlusion of anterior circulation were enrolled. CTP ASPECTS was evaluated on cerebral blood flow (CBF) and time-to-maximum (Tmax) colored maps, respectively. Automated perfusion analysis software was used to calculate the volumes of ischemic core (volume_CBF<30%) and tissue at risk (volume_Tmax>6s). Target mismatch was defined as volume_{CBF< 30%}<70ml, volume_mismatch≥15ml, and volume_{Tmax >6s}/volume _{CBF< 30%}≥1.8. Spearman correlation and receiver operating characteristic curves were used for statistical analyses.

Results: Strong correlations were found between CBF ASPECTS and volume_CBF<30%, and between Tmax ASPECTS and volume_Tmax>6s for overall population (ρ=-0.872, -0.757) and late-arriving patients (ρ=-0.900, -0.789). Mismatch ASPECTS moderately correlated with mismatch volume for overall population (ρ=0.498) and late-arriving patients (ρ=0.407). A CBF ASPECTS≥5 optimally predicted an ischemic core volume<70ml in overall population (sensitivity, 94.4%; specificity, 80.4%) and late-arriving patients (sensitivity, 89.5%; specificity, 90.5%). A CBF ASPECTS≥6 combined with a Mismatch ASPECTS≥1 optimally identified a target mismatch in overall population (sensitivity, 84.5%; specificity, 77.0%) and late-arriving patients (sensitivity, 83.7%; specificity, 90.0%).

Conclusion: CTP ASPECTS might be useful in predicting target mismatch derived from automated perfusion analysis software, and assisting in patient selection for endovascular therapy.

Keywords: Acute ischemic stroke; Alberta Stroke Program Early Computed Tomography Score; Computed tomography; Perfusion; Target mismatch.

MeSH terms

Alberta
Brain Ischemia* / diagnostic imaging
Cerebrovascular Circulation
Humans
Ischemic Stroke*
Perfusion
Perfusion Imaging / methods
Retrospective Studies
Stroke*
Tomography, X-Ray Computed / methods