Comparing the benefit of ASPECTS on maximum intensity projection images of computed tomography angiography to source images and noncontract computed tomography in predicting infarct volume and collaterals extent,Journal of Stroke & Cerebrovascular Diseases

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Comparing the benefit of ASPECTS on maximum intensity projection images of computed tomography angiography to source images and noncontract computed tomography in predicting infarct volume and collaterals extent
Journal of Stroke & Cerebrovascular Diseases ( IF 2.0 ) Pub Date : 2023-04-15 , DOI: 10.1016/j.jstrokecerebrovasdis.2023.107091
Seyed Amir Ebrahimzadeh ₁ , Elizabeth Du ₁ , Vladimir Ivanovic ₂ , Rafeeque A Bhadelia ₁ , Lotfi Hacein-Bey ₃ , Magdy Selim ₄ , Yu-Ming Chang ₁

Affiliation

Introduction

In acute ischemic strokes (AIS), the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and CT perfusion (CTP) are commonly used to determine mechanical thrombectomy eligibility. Prior work suggests that CTA source image (CTA-SI) ASPECTS (CTA_asp) and a newly described CTA maximum intensity projection (CTA-MIP) ASPECTS (MIP_asp) better predict the final infarct core. Our goal was to compare MIP_asp to CTA_asp and non-contrast CT ASPECTS (NCCT_asp) for predicting ischemic core and collaterals established by CTP.

Methods and materials

A single institution, retrospective database for AIS due to internal carotid artery (ICA) or proximal middle cerebral artery (MCA) occlusions between January 2016 and February 2021 was reviewed. We rated ASPECTS on NCCT, CTA-SI, and CTA-MIP at baseline, then used the automated RAPID software to measure CTP ischemic core volume. The accuracy of each ASPECTS in predicting ischemic core volume (ICV) >70 cc and Hypoperfusion intensity ratio (HIR) >0.4 was compared using the receiver operating characteristic (ROC) curve.

Results

122/319 patients fulfilled the inclusion criteria. Area under the curve (AUC) for MIP_asp was significantly higher than NCCT_asp and CTA_asp for predicting ICV >70 cc (0.95 vs. 0.89 and 0.95 vs. 0.92, P =0.03 and P = 0.04). For predicting HIR >0.4, AUC for MIP_asp was significantly higher than NCCT_asp and CTA_asp (0.85 vs. 0.72 and 0.85 vs. 0.81, P < 0.001 and P < 0.01).

Conclusion

The predictive accuracy of detecting ischemic stroke with ICV >70cc and HIR >0.4 can be significantly improved using the MIP_asp instead of CTA_asp or NCCT_asp.

中文翻译：

比较 ASPECTS 在计算机断层扫描血管造影的最大强度投影图像上与源图像和非收缩计算机断层扫描在预测梗塞体积和侧枝范围方面的优势

介绍

在急性缺血性中风(AIS) 中，阿尔伯塔中风计划早期计算机断层扫描评分 (ASPECTS) 和 CT 灌注 (CTP) 通常用于确定机械血栓切除术的资格。先前的工作表明 CTA 源图像 (CTA-SI) ASPECTS (CTA_asp ) 和新描述的 CTA 最大强度投影 (CTA-MIP) ASPECTS (MIP _asp ) 更好地预测最终的梗塞核心。我们的目标是将 MIP _asp与 CTA _asp和非对比 CT ASPECTS (NCCT _asp ) 进行比较，以预测 CTP 建立的缺血核心和侧枝。

方法和材料

审查了 2016 年 1 月至 2021 年 2 月期间因颈内动脉 (ICA) 或大脑中动脉近端 (MCA) 闭塞导致的 AIS 的单一机构回顾性数据库。我们在基线时对 NCCT、CTA-SI 和 CTA-MIP 的 ASPECTS 进行了评级，然后使用自动化 RAPID 软件测量 CTP 缺血核心体积。使用接受者操作特征 (ROC) 曲线比较每个 ASPECTS 在预测缺血核心体积 (ICV) > 70 cc 和低灌注强度比 (HIR) > 0.4 方面的准确性。

结果

122/319 名患者符合纳入标准。_{MIP asp}的曲线下面积 (AUC)在预测 ICV >70 cc 时显着高于 NCCT _asp和 CTA _{asp （0.95 对 0.89 和 0.95 对 0.92，P = 0.03 和 P = 0.04）。}对于预测 HIR >0.4，MIP _asp的 AUC显着高于 NCCT _asp和 CTA _asp（0.85 对 0.72 和 0.85 对 0.81，P < 0.001 和 P < 0.01）。