Cerebral Blood Volume ASPECTS Is the Best Predictor of Clinical Outcome in Acute Ischemic Stroke: A Retrospective, Combined Semi-Quantitative and Quantitative Assessment

• Published in: PloS one Vol. 11; no. 1; p. e0147910
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 29.01.2016; Public Library of Science (PLoS)
• Subjects: Abnormalities; Aged; Aged, 80 and over; Angiography; Biology and Life Sciences; Blood; Blood flow; Blood Flow Velocity - drug effects; Blood volume; Blood Volume - drug effects; Brain Ischemia - diagnosis; Brain Ischemia - diagnostic imaging; Brain Ischemia - drug therapy; Brain Ischemia - pathology; Care and treatment; Cerebral Angiography; Cerebral blood flow; Cerebral circulation; Cerebrovascular Circulation - drug effects; Cerebrum - blood supply; Cerebrum - drug effects; Cerebrum - pathology; Clinical outcomes; Clinical trials; Computed tomography; Cortex; Female; Fibrinolytic Agents - therapeutic use; Hemorrhage; Humans; Image Processing, Computer-Assisted; Inspection; Ischemia; Magnetic Resonance Angiography; Male; Measurement; Medical imaging; Medicine and Health Sciences; Middle Aged; Neurology; Neurosciences; Patient outcomes; Patients; Perfusion; Physiological aspects; Quality; Rehabilitation; Reperfusion; Research and Analysis Methods; Retrospective Studies; Stroke; Stroke - diagnosis; Stroke - diagnostic imaging; Stroke - drug therapy; Stroke - pathology; Tomography, X-Ray Computed; Transformation; Transit time; Treatment Outcome; Visual aspects; Canada; Italy
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0147910

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. 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. 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. 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.