title: Improved outcome prediction using CT angiography in addition to standard ischemic stroke assessment: results from the STOPStroke study.
abstract: OBJECTIVE
  To improve ischemic stroke outcome prediction using imaging information from a prospective cohort who received admission CT angiography (CTA).
  
  
  METHODS
  In a prospectively designed study, 649 stroke patients diagnosed with acute ischemic stroke had admission NIH stroke scale scores, noncontrast CT (NCCT), CTA, and 6-month outcome assessed using the modified Rankin scale (mRS) scores. Poor outcome was defined as mRS>2. Strokes were classified as "major" by the (1) Alberta Stroke Program Early CT Score (ASPECTS+) if NCCT ASPECTS was ≤7; (2) Boston Acute Stroke Imaging Scale (BASIS+) if they were ASPECTS+ or CTA showed occlusion of the distal internal carotid, proximal middle cerebral, or basilar arteries; and (3) NIHSS for scores >10.
  
  
  RESULTS
  Of 649 patients, 253 (39.0%) had poor outcomes. NIHSS, BASIS, and age, but not ASPECTS, were independent predictors of outcome. BASIS and NIHSS had similar sensitivities, both superior to ASPECTS (p<0.0001). Combining NIHSS with BASIS was highly predictive: 77.6% (114/147) classified as NIHSS>10/BASIS+ had poor outcomes, versus 21.5% (77/358) with NIHSS≤10/BASIS- (p<0.0001), regardless of treatment. The odds ratios for poor outcome is 12.6 (95% CI: 7.9 to 20.0) in patients who are NIHSS>10/BASIS+ compared to patients who are NIHSS≤10/BASIS-; the odds ratio is 5.4 (95% CI: 3.5 to 8.5) when compared to patients who are only NIHSS>10 or BASIS+.
  
  
  CONCLUSIONS
  BASIS and NIHSS are independent outcome predictors. Their combination is stronger than either instrument alone in predicting outcomes. The findings suggest that CTA is a significant clinical tool in routine acute stroke assessment.
authors.affiliation: Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America. rggonzalez@partners.org
authors.forename: R Gilberto
authors.initials: RG
authors.lastname: González
authors.forename: Michael H
authors.initials: MH
authors.lastname: Lev
authors.forename: Gregory V
authors.initials: GV
authors.lastname: Goldmacher
authors.forename: Wade S
authors.initials: WS
authors.lastname: Smith
authors.forename: Seyedmehdi
authors.initials: S
authors.lastname: Payabvash
authors.forename: Gordon J
authors.initials: GJ
authors.lastname: Harris
authors.forename: Elkan F
authors.initials: EF
authors.lastname: Halpern
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Koroshetz
authors.forename: Erica C S
authors.initials: EC
authors.lastname: Camargo
authors.forename: William P
authors.initials: WP
authors.lastname: Dillon
authors.forename: Karen L
authors.initials: KL
authors.lastname: Furie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*