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Cerebral Blood Volume ASPECTS Is the Best Predictor of Clinical Outcome in Acute Ischemic Stroke: A Retrospective, Combined Semi-Quantitative and Quantitative Assessment.
Padroni, Marina; Bernardoni, Andrea; Tamborino, Carmine; Roversi, Gloria; Borrelli, Massimo; Saletti, Andrea; De Vito, Alessandro; Azzini, Cristiano; Borgatti, Luca; Marcello, Onofrio; d'Esterre, Christopher; Ceruti, Stefano; Casetta, Ilaria; Lee, Ting-Yim; Fainardi, Enrico.
Afiliación
  • Padroni M; Section of Neurology, Department of Biological, Psychiatric and Psychological Science, University of Ferrara, Ferrara, Italy.
  • Bernardoni A; Section of Diagnostic Imaging, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
  • Tamborino C; Section of Neurology, Department of Biological, Psychiatric and Psychological Science, University of Ferrara, Ferrara, Italy.
  • Roversi G; Section of Neurology, Department of Biological, Psychiatric and Psychological Science, University of Ferrara, Ferrara, Italy.
  • Borrelli M; Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
  • Saletti A; Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
  • De Vito A; Neurology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
  • Azzini C; Neurology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
  • Borgatti L; Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
  • Marcello O; Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
  • d'Esterre C; Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
  • Ceruti S; Imaging Research Lab, Robarts Research Institute, Western Ontario University, London, Ontario, Canada.
  • Casetta I; Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
  • Lee TY; Section of Neurology, Department of Biological, Psychiatric and Psychological Science, University of Ferrara, Ferrara, Italy.
  • Fainardi E; Imaging Research Lab, Robarts Research Institute, Western Ontario University, London, Ontario, Canada.
PLoS One ; 11(1): e0147910, 2016.
Article en En | MEDLINE | ID: mdl-26824672
ABSTRACT

INTRODUCTION:

The capability of CT perfusion (CTP) Alberta Stroke Program Early CT Score (ASPECTS) to predict outcome and identify ischemia severity in acute ischemic stroke (AIS) patients is still questioned.

METHODS:

62 patients with AIS were imaged within 8 hours of symptom onset by non-contrast CT, CT angiography and CTP scans at admission and 24 hours. CTP ASPECTS was calculated on the affected hemisphere using cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) maps by subtracting 1 point for any abnormalities visually detected or measured within multiple cortical circular regions of interest according to previously established thresholds. MTT-CBV ASPECTS was considered as CTP ASPECTS mismatch. Hemorrhagic transformation (HT), recanalization status and reperfusion grade at 24 hours, final infarct volume at 7 days and modified Rankin scale (mRS) at 3 months after onset were recorded.

RESULTS:

Semi-quantitative and quantitative CTP ASPECTS were highly correlated (p<0.00001). CBF, CBV and MTT ASPECTS were higher in patients with no HT and mRS ≤ 2 and inversely associated with final infarct volume and mRS (p values from p<0.05 to p<0.00001). CTP ASPECTS mismatch was slightly associated with radiological and clinical outcomes (p values from p<0.05 to p<0.02) only if evaluated quantitatively. A CBV ASPECTS of 9 was the optimal semi-quantitative value for predicting outcome.

CONCLUSIONS:

Our findings suggest that visual inspection of CTP ASPECTS recognizes infarct and ischemic absolute values. Semi-quantitative CBV ASPECTS, but not CTP ASPECTS mismatch, represents a strong prognostic indicator, implying that core extent is the main determinant of outcome, irrespective of penumbra size.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Isquemia Encefálica / Angiografía por Resonancia Magnética / Accidente Cerebrovascular Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: PLoS One Asunto de la revista: CIENCIA / MEDICINA Año: 2016 Tipo del documento: Article País de afiliación: Italia

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Isquemia Encefálica / Angiografía por Resonancia Magnética / Accidente Cerebrovascular Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: PLoS One Asunto de la revista: CIENCIA / MEDICINA Año: 2016 Tipo del documento: Article País de afiliación: Italia