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Proposal of multimodal computed tomography-based scoring system in prediction of hemorrhagic transformation in acute ischemic stroke

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Abstract

Introduction

The routinely used computed tomography (CT)-based workup in the setting of acute ischemic stroke (AIS) includes non-contrast brain CT, CT angiography (CTA), and CT perfusion. Several CT, CTA, CTP-based radiological biomarkers of hemorrhagic transformation (HT) were reported.

Aim of the study

To assess the predictive value of the combined multimodal CT parameters for HT after AIS and proposal of predictive scoring scale.

Methods

The source images of the NCCT, CTA and CTP of 282 AIS patients involving the anterior circulation (HT = 91, non-HT = 191) were retrospectively reviewed and the following biomarkers were recorded and analyzed: Early subtle ischemic signs, hyperdense middle cerebral artery sign (HMCAS) and Alberta Stroke Program Early CT Score (ASPECTS) < 7 in NCCT, large-vessel occlusion (LVO), clot burden score (CBS) < 6, large-vessel occlusion, poor collateral score (CS) and Tmax > 6 s ≥ 56.5 ml. A scoring system to predict HT based on these biomarkers was developed. Each biomarker counts for a single point with the total score ranging from 0 to 7.

Results

All the aforementioned multimodal CT biomarkers and the selected cut offs were significantly associated with higher HT risk. The calculated scores were statistically significant different between the HT and the non-HT groups with AUC 0.761 (95% CI 0.703–0.819, P < 0.0000001). Rates of HT were approximately five times higher in patients with score ≥ 3.

Conclusion

Multimodal CT-based scoring system may provide highly reliable predictive model of hemorrhagic transformation in acute ischemic stroke.

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Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and confidentiality and are available from the corresponding author upon reasonable request.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Stroke Unit-Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy

    Nada Elsaid, Guido Bigliardi, Maria Luisa Dell’Acqua, Laura Vandelli, Ludovico Ciolli, Livio Picchetto, Giuseppe Borzì, Riccardo Ricceri, Roberta Pentore, Stefano Meletti & Ahmed Saied

  2. Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Nada Elsaid & Ahmed Saied

  3. Neuroradiology, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy

    Stefano Vallone

Authors
  1. Nada Elsaid
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  2. Guido Bigliardi
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  3. Maria Luisa Dell’Acqua
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  4. Laura Vandelli
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  5. Ludovico Ciolli
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  9. Roberta Pentore
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  11. Stefano Meletti
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  12. Ahmed Saied
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Contributions

NE, GB, AS: researched literature, conceived the study, gathered, analyzed, interpreted the data, and drafted the article. All authors reviewed and edited the manuscript and approved the final version of the manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Nada Elsaid.

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The authors declare that they have no conflict of interest.

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This was a retrospective observational study.

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Informed consent was obtained from all individual participants included in the study.

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Elsaid, N., Bigliardi, G., Dell’Acqua, M.L. et al. Proposal of multimodal computed tomography-based scoring system in prediction of hemorrhagic transformation in acute ischemic stroke. Acta Neurol Belg 123, 1405–1411 (2023). https://doi.org/10.1007/s13760-023-02239-5

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