title: MOSAIC: Multimodal Stroke Assessment Using Computed Tomography: novel diagnostic approach for the prediction of infarction size and clinical outcome.
abstract: OBJECTIVE
  With new CT technologies, including CT angiography (CTA), perfusion CT (PCT), and multidetector row technique, this method has regained interest for use in acute stroke assessment. We have developed a score system based on Multimodal Stroke Assessment Using CT (MOSAIC), which was evaluated in this prospective study.
  
  
  METHODS
  Forty-four acute stroke patients (mean age, 63.8 years) were enrolled within a mean of 3.0+/-1.9 hours after symptom onset. The MOSAIC score (0 to 8 points) was generated by results of the 3 sequential CT investigations: (1) presence and amount of early signs of infarction on noncontrast CT (NCCT; 0 to 2 points), (2) stenosis (>50%) or occlusion of the distal internal carotid or middle cerebral artery on CTA (0 to 2 points), and (3) presence and amount of reduced cerebral blood flow on 2 adjacent PCT slices (0 to 4 points). The predictive value of the MOSAIC score was compared with each single CT component with respect to the final size of infarction and the clinical outcome 3 months after stroke by use of the modified Rankin Scale (mRS) and the Barthel Index (BI).
  
  
  RESULTS
  Among the CT components, PCT showed the best correlation to infarction size (r=0.75) and clinical outcome (r=0.60 to 0.62) compared with NCCT (r=0.43 to 0.58) and CTA (r=0.47 to 0.71). The MOSAIC score showed consistently higher correlation factors (r=0.67 to 0.78) and higher predictive values (0.73 to 1.0) than all single CT components with respect to outcome measures. A MOSAIC score <4 predicted independence with 89% to 96% likelihood (mRS </=2, BI >/=90); a MOSAIC score <5 predicted fair outcome with 96% to 100% likelihood (mRS </=3, BI >/=60).
  
  
  CONCLUSIONS
  The MOSAIC score based on multidetector row CT technology is superior to NCCT, CTA, and PCT in predicting infarction size and clinical outcome in hyperacute stroke.
authors.affiliation: Department of Neurology, University of Münster, Münster, Forchheim, Germany. nabavi@uni-muenster.de
authors.forename: Darius G
authors.initials: DG
authors.lastname: Nabavi
authors.forename: Stephan P
authors.initials: SP
authors.lastname: Kloska
authors.forename: Eun-Mi
authors.initials: EM
authors.lastname: Nam
authors.forename: Michael
authors.initials: M
authors.lastname: Freund
authors.forename: Christiane G
authors.initials: CG
authors.lastname: Gaus
authors.forename: Ernst
authors.initials: E
authors.lastname: Klotz
authors.forename: Walter
authors.initials: W
authors.lastname: Heindel
authors.forename: E Bernd
authors.initials: EB
authors.lastname: Ringelstein
mesh_terms: D000208:Acute Disease; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D015996:Survival Rate; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D010959:Tissue Plasminogen Activator