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Multimodal CT pc-ASPECTS in infratentorial stroke: diagnostic and prognostic value

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Abstract

Background and purpose

Diagnosis of posterior circulation stroke may be challenged. National Institutes of Health Stroke Scale (NIHSS) and brain imaging (non-contrast brain computed tomography-CT) are used for diagnosis; evaluation on posterior circulation stroke remains a limit of NIHSS, and the value of non-contrast CT (NCCT) is limited due to artifacts caused by the bones of the base of the skull. We tested the validity and prognostic value of posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) in patients with posterior circulation stroke.

Methods

Pc-ASPECTS allots the posterior circulation 10 points. We studied 50 patients with posterior circulation stroke. We applied pc-ASPECTS to NCCT, CT angiography, and CT Perfusion. We evaluated the correlation of pc-ASPECT with outcome parameters for stroke.

Results

Out of 50 patients, CTP showed abnormalities in 34 cases. The pc-ASPECT score calculated on brain CT and on the brain CT + angio CT had a sensibility of 24%, calculated on brain CT, angio CT and CTPerfusion gain a sensibility of 72%. Pc-ASPECT MTT resulted to be the more reliable parameter: outcome given by NIHSS score at discharge, mRS at discharge, and at 3 months was more severe in patients with Pc-ASPECT MTT alteration. Outcome given by NIHSS score at discharge and mRS at discharge and 1 at 3 months was more severe in patients with higher NIHSS score at admission.

Conclusion

We evaluated the usefulness of pc-ASPECTS on CTP in predicting functional outcome in acute posterior circulation stroke that appears to be a powerful marker for predicting functional outcome.

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References

  1. De Marchis GM, Kohler A, Renz N, Arnold M, Mono ML, Jung S, Fischer U, Karameshev AI, Brekenfeld C, Gralla J, Schroth G, Mattle HP, Nedeltchev K (2011) Posterior versus anterior circulation strokes: comparison of clinical, radiological and outcome characteristics. J Neurol Neurosurg Psychiatry 82:33–37

    Article  Google Scholar 

  2. Markus HS, van der Worp HB, Rothwell PM (2013 Oct) Posterior circulation ischaemic stroke and transient ischaemic attack: diagnosis, investigation, and secondary prevention. Lancet Neurol 12(10):989–998

    Article  Google Scholar 

  3. Nouh A, Remke J, Ruland S (2014 Apr 7) Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management. Front Neurol 5:30. https://doi.org/10.3389/fneur.2014.00030

    Article  PubMed  PubMed Central  Google Scholar 

  4. Caplan LR, Wityk RJ, Glass TA, Tapia J, Pazdera L, Chang HM, Teal P, Dashe JF, Chaves CJ, Breen JC, Vemmos K, Amarenco P, Tettenborn B, Leary M, Estol C, Dewitt LD, Pessin MS (2004) New England medical center posterior circulation registry. Ann Neurol 56:389–398

    Article  Google Scholar 

  5. Bogousslavsky J, Van Melle G, Regli F (1988) The Lausanne Stroke Registry: analysis of 1,000 consecutive patients with first stroke. Stroke. 19(9):1083–1092

    Article  CAS  Google Scholar 

  6. Flossmann E (2003) Prognosis of vertebrobasilar transient ischaemic attack and minor stroke. Brain. 126(9):1940–1954

    Article  Google Scholar 

  7. Dewey HM, Sturm J, Donnan GA, Macdonell RAL, McNeil JJ, Thrift AG (2003) Incidence and Outcome of Subtypes of Ischaemic Stroke: Initial Results from the North East Melbourne Stroke Incidence Study (NEMESIS). Cerebrovasc Dis 15(1-2):133–139. https://doi.org/10.1159/000067142

    Article  PubMed  Google Scholar 

  8. Caplan LR (1979) Occlusion of the vertebral or basilar artery. Follow up analysis of some patients with benign outcome. Stroke. 10(3):277–282. https://doi.org/10.1161/01.STR.10.3.277

    Article  CAS  PubMed  Google Scholar 

  9. Tong DC, Yenari MA, Albers GW, O’Brien M, Marks MP, Mosley ME (1998) Correlation of perfusion- and diffusion-weighted MRI with NIHSS score in acute (6.5 hour) ischemic stroke. Neurology 50:864–870

    Article  CAS  Google Scholar 

  10. Furlanis G, Ajčević M, Stragapede L, Lugnan C, Ridolfi M, Caruso P, Manganotti P (2018) Ischemic volume and neurological deficit: correlation of computed tomography perfusion with the National Institutes of Health Stroke Scale Score in acute ischemic stroke. J Stroke Cerebrovasc Dis 27(8):2200–2207

    Article  Google Scholar 

  11. Ajčević, M., Furlanis, G., Stragapede, L., Ridolfi, M., Caruso, P., Naccarato, M., ... & Manganotti, P. (2019). Brain Oscillatory Activity and Neurological Deficit in Hyper-acute Ischemic Stroke: Correlation of EEG Changes with NIHSS. In: Mediterranean Conference on Medical and Biological Engineering and Computing. Springer, Cham, pp. 133-141

  12. Frankel MR, Morgenstern LB, Kwiatkowski T, Lu M, Tilley BC, Broderick JP, Libman R, Levine SR, Brott T (2000) Predicting prognosis after stroke: a placebo group analysis from the National Institute of Neurological Disorders and Stroke rt- PA Stroke Trial. Neurology 55:952–959

    Article  CAS  Google Scholar 

  13. Furlanis G, Ajčević M, Stella AB, Cillotto T, Caruso P, Ridolfi M et al (2019) Wake-up stroke: thrombolysis reduces ischemic lesion volume and neurological deficit. J Neurol 267(3):1–8

    Google Scholar 

  14. Olivato S, Nizzoli S, Cavazzuti M, Casoni F, Nichelli PF, Zini A (2016) e-NIHSS: an Expanded National Institutes of Health Stroke Scale Weighted for Anterior and Posterior Circulation Strokes. J Stroke Cerebrovasc Dis 25(12):2953–2957. https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.08.011

    Article  PubMed  Google Scholar 

  15. Schröder J, Thomalla G (2017) A Critical Review of Alberta Stroke Program Early CT Score for Evaluation of Acute Stroke Imaging. Front Neurol 7:245. https://doi.org/10.3389/fneur.2016.00245

    Article  PubMed  PubMed Central  Google Scholar 

  16. Barber PA, Demchuk AM, Zhang J, Buchan AM, for the ASPECTS Study Group (2000) Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet 355:1670–1674

    Article  CAS  Google Scholar 

  17. Puetz V, Sylaja PN, Coutts SB, Hill MD, Dzialowski I, Mueller P, Becker U, Urban G, O'Reilly C, Barber PA, Sharma P, Goyal M, Gahn G, von Kummer R, Demchuk AM (2008 Sep) Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke. 39(9):2485–2490. https://doi.org/10.1161/STROKEAHA.107.511162

    Article  PubMed  Google Scholar 

  18. Hwang DY, Silva GS, Furie KL, Greer DM (2012) Comparative sensitivity of computed tomography vs. magnetic resonance imaging for detecting acute posterior fossa infarct. J Emerg Med 42:559–565

    Article  Google Scholar 

  19. Sharon M, Boyle K, Yeung R, zhang L, Symons SP, Boulos MI, Aviv RI (2016) The predictive value of a targeted posterior fossa multimodal stroke protocol for the diagnosis of acute posterior ischemic stroke. Neurovascular Imaging 2(1):3. https://doi.org/10.1186/s40809-016-0013-6

    Article  Google Scholar 

  20. Alemseged F, Shah DG, Bivard A, Kleinig TJ, Yassi N, Diomedi M, di Giuliano F, Sharma G, Drew R, Yan B, Dowling RJ, Bush S, Sallustio F, Caltagirone C, Mercuri NB, Floris R, Parsons MW, Levi CR, Mitchell PJ, Davis SM, Campbell BCV (2019) Cerebral blood volume lesion extent predicts functional outcome in patients with vertebral and basilar artery occlusion. Int J Stroke 14(5):540–547. https://doi.org/10.1177/1747493017744465

    Article  PubMed  Google Scholar 

  21. Lev MH, Segal AZ, Farkas J, Hossain ST, Putman C, Hunter GJ, Budzik R, Harris GJ, Buonanno FS, Ezzeddine MA, Chang Y, Koroshetz WJ, Gonzalez RG, Schwamm LH (2001) Utility of perfusion-weighted CT imaging in acute middle cerebral artery stroke treated with intra-arterial thrombolysis: Prediction of final infarct volume and clinical outcome. Stroke. 32:2021–2028

    Article  CAS  Google Scholar 

  22. Perfusion CT PMW (2008) Is it Clinically Useful? Int J Stroke 3(1):41–50. https://doi.org/10.1111/j.1747-4949.2008.00175.x

    Article  Google Scholar 

  23. Wintermark M, Rowley HA, Lev MH (2009) Acute Stroke Triage to Intravenous Thrombolysis and Other Therapies with Advanced CT or MR Imaging: Pro CT. Radiology. 251(3):619–626. https://doi.org/10.1148/radiol.2513081073

    Article  PubMed  Google Scholar 

  24. d’Esterre CD, Roversi G, Padroni M, Bernardoni A, Tamborino C, de Vito A, Azzini C, Marcello O, Saletti A, Ceruti S, Lee TY, Fainardi E (2015) CT perfusion cerebral blood volume does not always predict infarct core in acute ischemic stroke. Neurol Sci 36(10):1777–1783. https://doi.org/10.1007/s10072-015-2244-8

    Article  PubMed  Google Scholar 

  25. Vilela P, Rowley HA (2017) Brain ischemia: CT and MRI techniques in acute ischemic stroke. Eur J Radiol 96:162–172

    Article  Google Scholar 

  26. Caruso P, Furlanis G, Ridolfi M, Ajcevic M, Naccarato M, Manganotti P (2019) Safety of Early Repeated Thrombolysis: A Case Report. Neurologist 24(5):143–145

    Article  Google Scholar 

  27. Manganotti P, Furlanis G, Ajčević M, Polverino P, Caruso P, Ridolfi M, Pozzi-Mucelli RA, Cova MA, Naccarato M (2019) CT perfusion and EEG patterns in patients with acute isolated aphasia in seizure-related stroke mimics. Seizure 71:110–115

    Article  Google Scholar 

  28. Stragapede L, Furlanis G, Ajčević M, Ridolfi M, Caruso P, Naccarato M, Ukmar M, Manganotti P (2019) Brain oscillatory activity and CT perfusion in hyper-acute ischemic stroke. J Clin Neurosci 69:184–189

    Article  Google Scholar 

  29. Caruso P, Naccarato M, Furlanis G, Ajčević M, Stragapede L, Ridolfi M, Polverino P, Ukmar M, Manganotti P (2018) Wake-up stroke and CT perfusion: effectiveness and safety of reperfusion therapy. Neurol Sci 39(10):1705–1712

    Article  Google Scholar 

  30. Van der Hoeven EJ, Dankbaar JW, Algra A, DUST investigator, et al. (2015) Additional diagnostic value of computed tomography perfusion for detection of acute ischemic stroke in the posterior circulation. Stroke 46:1113–1115

    Article  Google Scholar 

  31. Pallesen LP, Lambrou D, Eskandari A et al (2018) Perfusion computed tomography in posterior circulation stroke: predictors and prognostic implications of focal hypoperfusion. Eur J Neurol 25(5):725–731. https://doi.org/10.1111/ene.13578

    Article  PubMed  Google Scholar 

  32. Pallesen L-P, Gerber J, Dzialowski I et al (2015) Diagnostic and Prognostic impact of pc-ASPECTS Applied to Perfusion CT in the Basilar Artery International Cooperation Study. J Neuroimaging 25(3):384–389. https://doi.org/10.1111/jon.12130

    Article  PubMed  Google Scholar 

  33. Sporns P, Schmidt R, Minnerup J, Dziewas R, Kemmling A, Dittrich R, Zoubi T, Heermann P, Cnyrim C, Schwindt W, Heindel W, Niederstadt T, Hanning U (2016) Computed tomography perfusion improves diagnostic accuracy in acute posterior circulation stroke. Cerebrovasc Dis 41:242–247

    Article  Google Scholar 

  34. Ma H, Campbell BCV, Parsons MW, Churilov L, Levi CR, Hsu C, Kleinig TJ, Wijeratne T, Curtze S, Dewey HM, Miteff F, Tsai CH, Lee JT, Phan TG, Mahant N, Sun MC, Krause M, Sturm J, Grimley R, Chen CH, Hu CJ, Wong AA, Field D, Sun Y, Barber PA, Sabet A, Jannes J, Jeng JS, Clissold B, Markus R, Lin CH, Lien LM, Bladin CF, Christensen S, Yassi N, Sharma G, Bivard A, Desmond PM, Yan B, Mitchell PJ, Thijs V, Carey L, Meretoja A, Davis SM, Donnan GA (2019) Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke. N Engl J Med 380:1795–1803

    Article  Google Scholar 

  35. Wintermark M, Flanders AE, Velthuis B, Meuli R, van Leeuwen M, Goldsher D, Pineda C, Serena J, van der Schaaf I, Waaijer A, Anderson J, Nesbit G, Gabriely I, Medina V, Quiles A, Pohlman S, Quist M, Schnyder P, Bogousslavsky J, Dillon WP, Pedraza S (2006 Apr) Perfusion-CT assessment of infarct core and penumbra: receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke. 37(4):979–985

    Article  Google Scholar 

  36. De Lucas EM, Sanchez E, Gutierrez A (2008) CT protocol for acute stroke: tips and tricks for general radiologists. Radiographics 28:1673–1687

    Article  Google Scholar 

  37. Leiva-Salinas C, Provenzale JM, Kudo K, Sasaki M, Wintermark M (2012) The alphabet soup of perfusion CT and MR imaging: terminology revisited and clarified in five questions. Neuroradiology 54(9):907–918

    Article  Google Scholar 

  38. Gur AY, Lampl Y, Gross B, Royter V, Shopin L, Bornstein NM (2007 May) A new scale for assessing patients with vertebrobasilar stroke-the Israeli Vertebrobasilar Stroke Scale (IVBSS): inter-rater reliability and concurrent validity. Clin Neurol Neurosurg 109(4):317–322

    Article  Google Scholar 

  39. Higashida RT, Furlan AJ, Roberts H (2003) et-al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 34(8):e109–e137

    Article  Google Scholar 

  40. Bill O, Faouzi M, Meuli R, Maeder P, Wintermark M, Michel P (2017 Jan) Added value of multimodal computed tomography imaging: analysis of 1994 acute ischaemic strokes. Eur J Neurol 24(1):167–174

    Article  CAS  Google Scholar 

  41. Schonewille WJ, Wijman CA, Michel P et al (2009) Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol 8(8):724–730. https://doi.org/10.1016/S1474-4422(09)70173-5

    Article  PubMed  Google Scholar 

  42. Carpenter MB (1972). Core Text of Neuroanatomy. Williams & Wilkins.

  43. Thierfelder KM, Baumann AB, Sommer WH, Armbruster M, Opherk C, Janssen H, Reiser MF, Straube A, von Baumgarten L (2014) Vertebral Artery Hypoplasia. Stroke. 45(5):1363–1368. https://doi.org/10.1161/STROKEAHA.113.004188

    Article  PubMed  Google Scholar 

  44. Perren F, Poglia D, Landis T, Sztajzel R (2007) Vertebral artery hypoplasia: A predisposing factor for posterior circulation stroke? Neurology. 68(1):65–67

    Article  Google Scholar 

  45. Tei H, Uchiyama S, Usui T, Ohara K (2010) Posterior circulation ASPECTS on diffusion-weighted MRI can be a powerful marker for predicting functional outcome. J Neurol 257:767–773

    Article  Google Scholar 

  46. Engelter ST, Wetzel SG, Radue EW, Rausch M, Steck AJ, Lyrer PA (2004) The clinical significance of diffusion-weighted MR imaging in infratentorial strokes. Neurology 62:574–580

    Article  CAS  Google Scholar 

  47. Engelter ST, Wetzel SG, Bonati LH, Fluri F, Lyrer PA (2008) The clinical significance of diffusion-weighted MR imaging in stroke and TIA patients. Swiss Med Wkly 138:729–740

    PubMed  Google Scholar 

  48. Baird AE, Dambrosia J, Janket SJ, Eichbaum Q, Chaves C, Silver B, Barber PA, Parsons M, Darby D, Davis S, Caplan LR, Edelman RE, Warach S (2001) A three-item scale for the early prediction of stroke recovery. Lancet 357:2095–2099

    Article  CAS  Google Scholar 

  49. Wardlaw JM, Keir SL, Bastin ME, Armitage PA, Rana AK (2002) Is diffusion imaging appearance an independent predictor of outcome after ischemic stroke? Neurology 59:1381–1387

    Article  CAS  Google Scholar 

  50. Glass TA, Hennessey PM, Pazdera L, Chang H-M, Wityk RJ, Dewitt LD, Pessin MS, Caplan LR (2002) Outcome at 30 days in the New England Medical Center Posterior Circulation Registry. Arch Neurol 59:369–376

    Article  Google Scholar 

  51. Nagel S, Herweh C, Köhrmann M, Huttner HB, Poli S, Hartmann M, Hähnel S, Steiner T, Ringleb P, Hacke W (2012) MRI in Patients with Acute Basilar Artery Occlusion – DWI Lesion Scoring is an Independent Predictor of Outcome. Int J Stroke 7(4):282–288. https://doi.org/10.1111/j.1747-4949.2011.00705.x

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy

    Paola Caruso, Mariana Ridolfi, Carlo Lugnan, Milos Ajčević, Giovanni Furlanis, Giulia Bellavita, Marcello Naccarato, Alex Buoite Stella & Paolo Manganotti

  2. Department of Engineering and Architecture, University of Trieste, Via Alfonso Valerio, 10, 34127, Trieste, Italy

    Milos Ajčević

  3. Radiology Unit, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy

    Roberta Antea Pozzi Mucelli, Adrian Zdjelar & Maja Ukmar

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  1. Paola Caruso
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Correspondence to Paola Caruso.

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The study was approved by Institutional Review Board of ASUITs and by the regional ethics board of Friuli-Venezia Giulia, Italy (CEUR), in respect of the declaration of Helsinki. All authors have read and approved the submitted manuscript, and the manuscript has not been submitted elsewhere nor published elsewhere in whole or in part.

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Caruso, P., Ridolfi, M., Lugnan, C. et al. Multimodal CT pc-ASPECTS in infratentorial stroke: diagnostic and prognostic value. Neurol Sci 42, 4231–4240 (2021). https://doi.org/10.1007/s10072-021-05072-x

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