title: Contribution and additional impact of imaging to the SPAN-100 score.
abstract: OBJECTIVE
  Stroke Prognostication by Using Age and NIHSS score (SPAN-100 index) facilitates stroke outcomes. We assessed imaging markers associated with the SPAN-100 index and their additional impact on outcome determination.
  
  
  METHODS
  Of 273 consecutive patients with acute ischemic stroke (<4.5 hours), 55 were characterized as SPAN-100-positive (age +NIHSS score ≥ 100). A comprehensive imaging review evaluated differences, using the presence of the hyperattenuated vessel sign, ASPECTS, clot burden score, collateral score, CBV, CBF, and MTT. The primary outcome assessed was favorable outcome (mRS ≤ 2). Secondary outcomes included recanalization, lack of neurologic improvement, and hemorrhagic transformation. Uni- and multivariate analyses assessed factors associated with favorable outcome. Area under the curve evaluated predictors of favorable clinical outcome.
  
  
  RESULTS
  Compared with the SPAN-100-negative group, the SPAN-100-positive group (55/273; 20%) demonstrated larger CBVs (<0.001), poorer collaterals (P < .001), and increased hemorrhagic transformation rates (56.0% versus 36%, P = .02) despite earlier time to rtPA (P = .03). Favorable outcome was less common among patients with SPAN-100-positive compared with SPAN-100-negative (10.9% versus 42.2%; P < .001). Multivariate regression revealed poorer outcome for SPAN-100-positive (OR = 0.17; 95% CI, 0.06-0.38; P = .001), clot burden score (OR = 1.14; 95% CI, 1.05-1.25; P < .001), and CBV (OR = 0.58; 95% CI, 0.46-0.72; P = .001). The addition of the clot burden score and CBV improved the predictive value of SPAN-100 alone for favorable outcome from 60% to 68% and 74%, respectively.
  
  
  CONCLUSIONS
  SPAN-100-positivity predicts a lower likelihood of favorable outcome and increased hemorrhagic transformation. CBV and clot burden score contribute to poorer outcomes among high-risk patients and improve stroke-outcome prediction.
authors.affiliation: From the Division of Neuroradiology (P.K., S.S., R.A.), Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Krishnan
authors.affiliation: Stroke Outcome Reach Center (G.S.), Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Ontario, Canada.
authors.forename: G
authors.initials: G
authors.lastname: Saposnik
authors.affiliation: Department of Neurosciences (B.O.), Medical University of South Carolina, Charleston, South Carolina.
authors.forename: B
authors.initials: B
authors.lastname: Ovbiagele
authors.affiliation: Biostatistician (L.Z.), Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Zhang
authors.affiliation: From the Division of Neuroradiology (P.K., S.S., R.A.), Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Symons
authors.affiliation: From the Division of Neuroradiology (P.K., S.S., R.A.), Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada richard.aviv@sunnybrook.ca.
authors.forename: R
authors.initials: R
authors.lastname: Aviv
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000175:diagnosis*; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020767:Intracranial Thrombosis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D016896:Treatment Outcome