title: External validation of the Boston Acute Stroke Imaging Scale and M1-BASIS in thrombolyzed patients.
abstract: OBJECTIVE
  Radiological findings play an essential role in therapeutic decision making and prognostication in acute ischemic stroke (AIS). The Boston Acute Stroke Imaging Scale (BASIS) and Middle Cerebral Artery-BASIS (M1-BASIS) methodologies are rapid purely radiological instruments and easily applicable for patients with AIS. We validated these methods in patients with AIS treated with intravenous tissue-type plasminogen activator.
  
  
  METHODS
  For BASIS, patients were labeled as having major stroke if there was occlusion of distal internal carotid artery, proximal (both M1 and M2 segments) of middle cerebral artery or the basilar artery, or an Alberta Stroke Program Early CT Score≤7. M1-BASIS differs from BASIS by classifying AIS patients with M2 occlusion as a minor stroke. We evaluated these classification systems for predicting functional outcomes (modified Rankin Scale score 0-1) at 3 months.
  
  
  RESULTS
  Two hundred sixty-five consecutive AIS patients treated with intravenous tissue-type plasminogen activator were included. On multivariate analysis, younger age (odds ratio, 1.039, 95% confidence interval, 1.009-1.070; P=0.011), lower National Institutes of Health Stroke Scale score (odds ratio, 1.140; 95% confidence interval, 1.073-1.210; P<0.001), and minor stroke by M1-BASIS (odds ratio, 2.376; 95% confidence interval, 1.047-5.393; P=0.039) were independent predictors of good functional outcome. When compared with National Institutes of Health Stroke Scale, the receiver operating characteristic curves for both BASIS (area under the curve, 0.721) and M1-BASIS (area under the curve, 0.795) correlated well with clinical severity scores. M1-BASIS has an additive effect with the National Institutes of Health Stroke Scale score to predict good outcomes.
  
  
  CONCLUSIONS
  The purely radiological M1-BASIS correlates well with the clinical severity of stroke and can be a reliable prognostication tool in thrombolyzed AIS patients. This system might find an important place in the current era of telestroke.
authors.affiliation: From the Divisions of Neurology (L.L.L.Y., P.R.P., B.W., H.L.T., A.A., R.C.S., B.P.C., R.R., V.K.S.), Endocrinology (C.M.K.), Respiratory and Critical Care Medicine (V.O.), and Department of Diagnostic Imaging (E.Y.T., A.G.), National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (R.C.S., V.K.S.); and National Brain Center, Indonesia (K.Y.). leonard_ll_yeo@nuhs.edu.sg.
authors.forename: Leonard L L
authors.initials: LL
authors.lastname: Yeo
authors.affiliation: From the Divisions of Neurology (L.L.L.Y., P.R.P., B.W., H.L.T., A.A., R.C.S., B.P.C., R.R., V.K.S.), Endocrinology (C.M.K.), Respiratory and Critical Care Medicine (V.O.), and Department of Diagnostic Imaging (E.Y.T., A.G.), National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (R.C.S., V.K.S.); and National Brain Center, Indonesia (K.Y.).
authors.forename: Prakash R
authors.initials: PR
authors.lastname: Paliwal
authors.affiliation: From the Divisions of Neurology (L.L.L.Y., P.R.P., B.W., H.L.T., A.A., R.C.S., B.P.C., R.R., V.K.S.), Endocrinology (C.M.K.), Respiratory and Critical Care Medicine (V.O.), and Department of Diagnostic Imaging (E.Y.T., A.G.), National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (R.C.S., V.K.S.); and National Brain Center, Indonesia (K.Y.).
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wakerley
authors.affiliation: From the Divisions of Neurology (L.L.L.Y., P.R.P., B.W., H.L.T., A.A., R.C.S., B.P.C., R.R., V.K.S.), Endocrinology (C.M.K.), Respiratory and Critical Care Medicine (V.O.), and Department of Diagnostic Imaging (E.Y.T., A.G.), National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (R.C.S., V.K.S.); and National Brain Center, Indonesia (K.Y.).
authors.forename: Chin M
authors.initials: CM
authors.lastname: Khoo
authors.affiliation: From the Divisions of Neurology (L.L.L.Y., P.R.P., B.W., H.L.T., A.A., R.C.S., B.P.C., R.R., V.K.S.), Endocrinology (C.M.K.), Respiratory and Critical Care Medicine (V.O.), and Department of Diagnostic Imaging (E.Y.T., A.G.), National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (R.C.S., V.K.S.); and National Brain Center, Indonesia (K.Y.).
authors.forename: Hock L
authors.initials: HL
authors.lastname: Teoh
authors.affiliation: From the Divisions of Neurology (L.L.L.Y., P.R.P., B.W., H.L.T., A.A., R.C.S., B.P.C., R.R., V.K.S.), Endocrinology (C.M.K.), Respiratory and Critical Care Medicine (V.O.), and Department of Diagnostic Imaging (E.Y.T., A.G.), National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (R.C.S., V.K.S.); and National Brain Center, Indonesia (K.Y.).
authors.forename: Aftab
authors.initials: A
authors.lastname: Ahmad
authors.affiliation: From the Divisions of Neurology (L.L.L.Y., P.R.P., B.W., H.L.T., A.A., R.C.S., B.P.C., R.R., V.K.S.), Endocrinology (C.M.K.), Respiratory and Critical Care Medicine (V.O.), and Department of Diagnostic Imaging (E.Y.T., A.G.), National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (R.C.S., V.K.S.); and National Brain Center, Indonesia (K.Y.).
authors.forename: Eric Y
authors.initials: EY
authors.lastname: Ting
authors.affiliation: From the Divisions of Neurology (L.L.L.Y., P.R.P., B.W., H.L.T., A.A., R.C.S., B.P.C., R.R., V.K.S.), Endocrinology (C.M.K.), Respiratory and Critical Care Medicine (V.O.), and Department of Diagnostic Imaging (E.Y.T., A.G.), National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (R.C.S., V.K.S.); and National Brain Center, Indonesia (K.Y.).
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Seet
authors.affiliation: From the Divisions of Neurology (L.L.L.Y., P.R.P., B.W., H.L.T., A.A., R.C.S., B.P.C., R.R., V.K.S.), Endocrinology (C.M.K.), Respiratory and Critical Care Medicine (V.O.), and Department of Diagnostic Imaging (E.Y.T., A.G.), National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (R.C.S., V.K.S.); and National Brain Center, Indonesia (K.Y.).
authors.forename: Venetia
authors.initials: V
authors.lastname: Ong
authors.affiliation: From the Divisions of Neurology (L.L.L.Y., P.R.P., B.W., H.L.T., A.A., R.C.S., B.P.C., R.R., V.K.S.), Endocrinology (C.M.K.), Respiratory and Critical Care Medicine (V.O.), and Department of Diagnostic Imaging (E.Y.T., A.G.), National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (R.C.S., V.K.S.); and National Brain Center, Indonesia (K.Y.).
authors.forename: Bernard P
authors.initials: BP
authors.lastname: Chan
authors.affiliation: From the Divisions of Neurology (L.L.L.Y., P.R.P., B.W., H.L.T., A.A., R.C.S., B.P.C., R.R., V.K.S.), Endocrinology (C.M.K.), Respiratory and Critical Care Medicine (V.O.), and Department of Diagnostic Imaging (E.Y.T., A.G.), National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (R.C.S., V.K.S.); and National Brain Center, Indonesia (K.Y.).
authors.forename: Kusama
authors.initials: K
authors.lastname: Yohanna
authors.affiliation: From the Divisions of Neurology (L.L.L.Y., P.R.P., B.W., H.L.T., A.A., R.C.S., B.P.C., R.R., V.K.S.), Endocrinology (C.M.K.), Respiratory and Critical Care Medicine (V.O.), and Department of Diagnostic Imaging (E.Y.T., A.G.), National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (R.C.S., V.K.S.); and National Brain Center, Indonesia (K.Y.).
authors.forename: Anil
authors.initials: A
authors.lastname: Gopinathan
authors.affiliation: From the Divisions of Neurology (L.L.L.Y., P.R.P., B.W., H.L.T., A.A., R.C.S., B.P.C., R.R., V.K.S.), Endocrinology (C.M.K.), Respiratory and Critical Care Medicine (V.O.), and Department of Diagnostic Imaging (E.Y.T., A.G.), National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (R.C.S., V.K.S.); and National Brain Center, Indonesia (K.Y.).
authors.forename: Rahul
authors.initials: R
authors.lastname: Rathakrishnan
authors.affiliation: From the Divisions of Neurology (L.L.L.Y., P.R.P., B.W., H.L.T., A.A., R.C.S., B.P.C., R.R., V.K.S.), Endocrinology (C.M.K.), Respiratory and Critical Care Medicine (V.O.), and Department of Diagnostic Imaging (E.Y.T., A.G.), National University Health System, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (R.C.S., V.K.S.); and National Brain Center, Indonesia (K.Y.).
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002533:Cerebral Angiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D020127:Recovery of Function; D020521:Stroke / Q000145:classification* / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: BASIS, computed tomography; thrombolytic therapy