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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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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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  2. Mariana Ridolfi
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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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