Purpose

Non-contrast CT ASPECTS (NCCT_asp) has an established role in determining eligibility for mechanical thrombectomy in centers without ready access to perfusion or DWI. Moreover, it has been suggested that CTA source ASPECTS (CTA_asp) may be superior to NCCT_asp in predicting final infarct volume (FIV). In this study, we hypothesized that CTA maximum intensity projection ASPECTS (MIPS_asp) would be superior compared to both NCCT_asp and CTA_asp in predicting FIV as measured by DWI.

Materials and Methods

In 41 consecutive patients with MCA territory infarcts, NCCT_asp, CTA_asp and MIPS_asp were visually assessed by 2 neuroradiologists. Disagreements were adjudicated by a third neuroradiologist, and the reconciled data used for all further analysis. MR-DWI was used as the standard for FIV determination. Receiver operating characteristic curve analysis was used to compare the area under the curve for all three CT-based methods in predicting FIV ≥70 ml.

Results

MIPS_asp (AUC: 0.98, CI: 0.88–1.00) were statistically better than NCCT_asp (AUC: 0.87, 95% CI: 0.72–0.95; p=0.01) in predicting FIV ≥70 ml. MIPS_asp were also superior to CTA_asp (AUC: 0.9, CI: 0.79–.98; p˂0.05). Optimal test performance for predicting FIV ≥70 ml for MIPS_asp was ≤6 (sensitivity=100%, specificity=91.4%; Youden's J=0.98).

Conclusion

Our preliminary study suggests that a novel CTA-MIPS derived ASPECTS better predicts large MCA territory infarcts compared to CTA source and non-contrast ASPECTS. Thus, MIPS_asp may be a promising technique for future studies aimed at improving ischemic stroke treatment in centers using ASPECTS for stroke management.

中文翻译：

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用于ASPECTS派生和大面积梗死体积检测的脑计算机断层扫描血管造影术最大强度投影图像：初步研究

目的

无对比CT ASPECTS（NCCT _asp）在确定没有准备好进行灌注或DWI的中心确定机械血栓切除术的资格时已确立了作用。而且，已经提出，在预测最终梗塞体积（FIV）方面，CTA源ASPECTS（CTA _asp）可能优于NCCT _asp。在这项研究中，我们假设CTA最大强度投影ASPECTS（MIPS _asp）在预测DIV测量的FIV方面优于NCCT _asp和CTA _asp。

材料和方法

在连续的41位MCA区域梗死患者中，由2位神经放射科医生对NCCT _asp，CTA _asp和MIPS _asp进行了视觉评估。分歧由第三位神经放射科医生裁定，对帐后的数据用于所有进一步分析。MR-DWI被用作FIV测定的标准。接受者工作特征曲线分析用于比较所有三种基于CT的方法预测FIV≥70 ml时曲线下的面积。

结果

在预测FIV≥70 ml时，MIPS _asp（AUC：0.98，CI：0.88–1.00）在统计学上优于NCCT _asp（AUC：0.87，95％CI：0.72–0.95; p = 0.01）。MIPS _ASP也优于CTA _ASP（AUC：0.9，CI：0.79 0.98; p ˂0.05）。预测MIPS _asp的FIV≥70 ml的最佳测试性能为≤6（灵敏度= 100％，特异性= 91.4％； Youden J = 0.98）。

结论

我们的初步研究表明，与CTA来源和非对比ASPECTS相比，源自CTA-MIPS的新型ASPECTS可以更好地预测MCA大面积梗塞。因此，MIPS _asp可能是用于未来研究的一项有前途的技术，旨在改善使用ASPECTS进行中风管理的中心缺血性中风的治疗。