title: Alberta stroke program early computed tomographic scoring performance in a series of patients undergoing computed tomography and MRI: reader agreement, modality agreement, and outcome prediction.
abstract: OBJECTIVE
  In this study, we compare the performance of pretreatment Alberta Stroke Program Early Computed Tomographic scoring (ASPECTS) using noncontrast CT (NCCT) and MRI in a large endovascular therapy cohort.
  
  
  METHODS
  Prospectively enrolled patients underwent baseline NCCT and MRI and started endovascular therapy within 12 hours of stroke onset. Inclusion criteria for this analysis were evaluable pretreatment NCCT, diffusion-weighted MRI (DWI), and 90-day modified Rankin Scale scores. Two expert readers graded ischemic change on NCCT and DWI using the ASPECTS. ASPECTS scores were analyzed with the full scale or were trichotomized (0-4 versus 5-7 versus 8-10) or dichotomized (0-7 versus 8-10). Good functional outcome was defined as a 90-day modified Rankin Scale score of 0 to 2.
  
  
  RESULTS
  Seventy-four patients fulfilled our study criteria. The full-scale inter-rater agreement for CT-ASPECTS and DWI-ASPECTS was 0.579 and 0.867, respectively. DWI-ASPECTS correlated with functional outcome (P=0.004), whereas CT-ASPECTS did not (P=0.534). Both DWI-ASPECTS and CT-ASPECTS correlated with DWI volume. The receiver operating characteristic analysis revealed that DWI-ASPECTS outperformed both CT-ASPECTS and the time interval between symptom onset and start of the procedure for predicting good functional outcome (modified Rankin Scale score, ≤2) and DWI volume ≥70 mL.
  
  
  CONCLUSIONS
  Inter-rater agreement for DWI-ASPECTS was superior to that for CT-ASPECTS. DWI-ASPECTS outperformed NCCT ASPECTS for predicting functional outcome at 90 days.
authors.affiliation: From the Department of Neurosurgery, Cleveland Clinic Florida, Weston (R.A.M.); Cerebrovascular Center, Cleveland Clinic, OH (R.A.M.); Department of Neurology, University of Pittsburgh School of Medicine, PA (T.G.J.); Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L., M.M., O.A.C., M.I, M.P.M., G.W.A.); and Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence (M.V.J.). mctaggr@ccf.org.
authors.forename: Ryan A
authors.initials: RA
authors.lastname: McTaggart
authors.affiliation: From the Department of Neurosurgery, Cleveland Clinic Florida, Weston (R.A.M.); Cerebrovascular Center, Cleveland Clinic, OH (R.A.M.); Department of Neurology, University of Pittsburgh School of Medicine, PA (T.G.J.); Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L., M.M., O.A.C., M.I, M.P.M., G.W.A.); and Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence (M.V.J.).
authors.forename: Tudor G
authors.initials: TG
authors.lastname: Jovin
authors.affiliation: From the Department of Neurosurgery, Cleveland Clinic Florida, Weston (R.A.M.); Cerebrovascular Center, Cleveland Clinic, OH (R.A.M.); Department of Neurology, University of Pittsburgh School of Medicine, PA (T.G.J.); Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L., M.M., O.A.C., M.I, M.P.M., G.W.A.); and Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence (M.V.J.).
authors.forename: Maarten G
authors.initials: MG
authors.lastname: Lansberg
authors.affiliation: From the Department of Neurosurgery, Cleveland Clinic Florida, Weston (R.A.M.); Cerebrovascular Center, Cleveland Clinic, OH (R.A.M.); Department of Neurology, University of Pittsburgh School of Medicine, PA (T.G.J.); Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L., M.M., O.A.C., M.I, M.P.M., G.W.A.); and Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence (M.V.J.).
authors.forename: Michael
authors.initials: M
authors.lastname: Mlynash
authors.affiliation: From the Department of Neurosurgery, Cleveland Clinic Florida, Weston (R.A.M.); Cerebrovascular Center, Cleveland Clinic, OH (R.A.M.); Department of Neurology, University of Pittsburgh School of Medicine, PA (T.G.J.); Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L., M.M., O.A.C., M.I, M.P.M., G.W.A.); and Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence (M.V.J.).
authors.forename: Mahesh V
authors.initials: MV
authors.lastname: Jayaraman
authors.affiliation: From the Department of Neurosurgery, Cleveland Clinic Florida, Weston (R.A.M.); Cerebrovascular Center, Cleveland Clinic, OH (R.A.M.); Department of Neurology, University of Pittsburgh School of Medicine, PA (T.G.J.); Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L., M.M., O.A.C., M.I, M.P.M., G.W.A.); and Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence (M.V.J.).
authors.forename: Omar A
authors.initials: OA
authors.lastname: Choudhri
authors.affiliation: From the Department of Neurosurgery, Cleveland Clinic Florida, Weston (R.A.M.); Cerebrovascular Center, Cleveland Clinic, OH (R.A.M.); Department of Neurology, University of Pittsburgh School of Medicine, PA (T.G.J.); Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L., M.M., O.A.C., M.I, M.P.M., G.W.A.); and Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence (M.V.J.).
authors.forename: Manabu
authors.initials: M
authors.lastname: Inoue
authors.affiliation: From the Department of Neurosurgery, Cleveland Clinic Florida, Weston (R.A.M.); Cerebrovascular Center, Cleveland Clinic, OH (R.A.M.); Department of Neurology, University of Pittsburgh School of Medicine, PA (T.G.J.); Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L., M.M., O.A.C., M.I, M.P.M., G.W.A.); and Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence (M.V.J.).
authors.forename: Michael P
authors.initials: MP
authors.lastname: Marks
authors.affiliation: From the Department of Neurosurgery, Cleveland Clinic Florida, Weston (R.A.M.); Cerebrovascular Center, Cleveland Clinic, OH (R.A.M.); Department of Neurology, University of Pittsburgh School of Medicine, PA (T.G.J.); Stanford Stroke Center, Stanford University School of Medicine, CA (M.G.L., M.M., O.A.C., M.I, M.P.M., G.W.A.); and Department of Diagnostic Imaging, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence (M.V.J.).
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Albers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000592:standards*; D016896:Treatment Outcome
keywords: brain ischemia; diffusion magnetic resonance imaging; multi-slice computed tomography; stroke; thrombectomy