title: Early ischemic change on CT versus diffusion-weighted imaging for patients with stroke receiving intravenous recombinant tissue-type plasminogen activator therapy: stroke acute management with urgent risk-factor assessment and improvement (SAMURAI) rt-PA registry.
abstract: OBJECTIVE
  Alberta Stroke Programme Early CT Score (ASPECTS) is a quantitative topographical score to evaluate early ischemic change in the middle cerebral arterial territory on CT as well as on diffusion-weighted imaging (DWI). The aim of the present study was to elucidate the relationship between CT-ASPECTS and DWI-ASPECTS for patients with hyperacute stroke and their associations with outcomes after recombinant tissue-type plasminogen activator therapy based on a multicenter registry.
  
  
  METHODS
  ASPECTS was assessed on both CT and DWI before intravenous 0.6 mg/kg alteplase in 360 patients with stroke (119 women, 71 ± 11 years old). The outcomes were symptomatic intracerebral hemorrhage within 36 hours and independence at 3 months defined by a modified Rankin Scale score of 0 to 2.
  
  
  RESULTS
  DWI-ASPECTS was positively correlated with CT-ASPECTS (ρ=0.511, P<0.001) and was lower than CT-ASPECTS (median 8 [interquartile range, 6 to 9] versus 9 [8 to 10], P<0.001). Higher baseline National Institutes of Health Stroke Scale score (standardized partial regression coefficient [β] 0.061, P<0.001) and cardioembolic stroke (β 0.35, P<0.001) were related to this discrepancy. The area under the receiver operating characteristic curve for predicting sICH (12 patients) using ASPECTS was 0.673 (95% CI, 0.503 to 0.807) by CT and 0.764 (95% CI, 0.635 to 0.858) by DWI (P=0.275). The area for predicting independence at 3 months (192 patients) was 0.621 (0.564 to 0.674) by CT and 0.639 (0.580 to 0.694) by DWI (P=0.535).
  
  
  CONCLUSIONS
  For patients with hyperacute stroke, DWI-ASPECTS scored approximately 1 point lower than CT-ASPECTS. Both CT-ASPECTS and DWI-ASPECTS were useful predictors of symptomatic intracerebral hemorrhage and independence at 3 months after recombinant tissue-type plasminogen activator.
authors: Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka 565-8565, Japan.
authors: Tomohisa
authors: T
authors: Nezu
authors: Masatoshi
authors: M
authors: Koga
authors: Jyoji
authors: J
authors: Nakagawara
authors: Yoshiaki
authors: Y
authors: Shiokawa
authors: Hiroshi
authors: H
authors: Yamagami
authors: Eisuke
authors: E
authors: Furui
authors: Kazumi
authors: K
authors: Kimura
authors: Yasuhiro
authors: Y
authors: Hasegawa
authors: Yasushi
authors: Y
authors: Okada
authors: Satoshi
authors: S
authors: Okuda
authors: Kazuomi
authors: K
authors: Kario
authors: Masaki
authors: M
authors: Naganuma
authors: Koichiro
authors: K
authors: Maeda
authors: Kazuo
authors: K
authors: Minematsu
authors: Kazunori
authors: K
authors: Toyoda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator