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Diagnostic accuracy of using Alberta Stroke Program Early Computed Tomography Score on CT perfusion map to predict a target mismatch in patients with acute ischemic stroke

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

To assess the diagnostic accuracy of using Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on CT perfusion (CTP) map to predict a volumetric target mismatch in patients with acute ischemic stroke (AIS).

Methods

Three-hundred and seven AIS patients with an onset time within 24h or unclear onset time who underwent CTP evaluation for large vessel occlusion of anterior circulation were enrolled. CTP ASPECTS was evaluated on cerebral blood flow (CBF) and time-to-maximum (Tmax) colored maps, respectively. Automated perfusion analysis software was used to calculate the volumes of ischemic core (volumeCBF<30%) and tissue at risk (volumeTmax>6s). Target mismatch was defined as volumeCBF< 30%<70ml, volumemismatch≥15ml, and volumeTmax >6s/volume CBF< 30%≥1.8. Spearman correlation and receiver operating characteristic curves were used for statistical analyses.

Results

Strong correlations were found between CBF ASPECTS and volumeCBF<30%, and between Tmax ASPECTS and volumeTmax>6s for overall population (ρ=−0.872, −0.757) and late-arriving patients (ρ=−0.900, −0.789). Mismatch ASPECTS moderately correlated with mismatch volume for overall population (ρ=0.498) and late-arriving patients (ρ=0.407). A CBF ASPECTS≥5 optimally predicted an ischemic core volume<70ml in overall population (sensitivity, 94.4%; specificity, 80.4%) and late-arriving patients (sensitivity, 89.5%; specificity, 90.5%). A CBF ASPECTS≥6 combined with a Mismatch ASPECTS≥1 optimally identified a target mismatch in overall population (sensitivity, 84.5%; specificity, 77.0%) and late-arriving patients (sensitivity, 83.7%; specificity, 90.0%).

Conclusion

CTP ASPECTS might be useful in predicting target mismatch derived from automated perfusion analysis software, and assisting in patient selection for endovascular therapy.

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Availability of data

The raw data of this article is available upon reasonable request from the corresponding author (FYW).

Funding

This research is founded by the National Natural Science Foundation of China (grant number: 82171907 to Shan-shan Lu; 81971613 to Hai-Bin Shi).

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Authors and Affiliations

  1. Department of Radiology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd., Nanjing, China

    Yue Chu, Guang-Chen Shen, Gao Ma, Xiao-Quan Xu, Shan-Shan Lu & Fei-Yun Wu

  2. Department of Emergency, First Affiliated Hospital of Nanjing Medical University, Nanjing, China

    Lei Jiang

  3. Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China

    Sheng Liu & Hai-Bin Shi

Authors
  1. Yue Chu
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  2. Guang-Chen Shen
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  3. Gao Ma
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  4. Xiao-Quan Xu
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  5. Shan-Shan Lu
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  6. Lei Jiang
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  7. Sheng Liu
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  8. Hai-Bin Shi
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  9. Fei-Yun Wu
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Contributions

Yue Chu: conceptualization; data curation; formal analysis; methodology; writing original draft. Guang-Chen Shen: conceptualization; data curation; formal analysis; methodology; visualization. Gao Ma: formal analysis; methodology; validation. Xiao-Quan Xu: conceptualization; supervision; project administration. Shan-Shan Lu: formal analysis; methodology; funding acquisition; validation. Lei Jiang: conceptualization; resources; validation. Sheng Liu: conceptualization; resources; validation. Hai-Bin Shi: conceptualization; supervision; funding acquisition. Fei-Yun Wu: conceptualization; supervision; project administration; funding acquisition. The manuscript has been read and approved by all the authors.

Corresponding authors

Correspondence to Xiao-Quan Xu or Fei-Yun Wu.

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The authors declare no competing interests.

Ethics approval

The study was approved by the First Hospital of Nanjing Medical University’s ethical committee for studies in humans.

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The requirement for a written informed consent was waived due to the retrospective nature of the study.

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Chu, Y., Shen, GC., Ma, G. et al. Diagnostic accuracy of using Alberta Stroke Program Early Computed Tomography Score on CT perfusion map to predict a target mismatch in patients with acute ischemic stroke. Neuroradiology 64, 1321–1330 (2022). https://doi.org/10.1007/s00234-021-02892-8

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