title: Cerebral Blood Volume ASPECTS Is the Best Predictor of Clinical Outcome in Acute Ischemic Stroke: A Retrospective, Combined Semi-Quantitative and Quantitative Assessment.
abstract: BACKGROUND
  The capability of CT perfusion (CTP) Alberta Stroke Program Early CT Score (ASPECTS) to predict outcome and identify ischemia severity in acute ischemic stroke (AIS) patients is still questioned.
  
  
  METHODS
  62 patients with AIS were imaged within 8 hours of symptom onset by non-contrast CT, CT angiography and CTP scans at admission and 24 hours. CTP ASPECTS was calculated on the affected hemisphere using cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) maps by subtracting 1 point for any abnormalities visually detected or measured within multiple cortical circular regions of interest according to previously established thresholds. MTT-CBV ASPECTS was considered as CTP ASPECTS mismatch. Hemorrhagic transformation (HT), recanalization status and reperfusion grade at 24 hours, final infarct volume at 7 days and modified Rankin scale (mRS) at 3 months after onset were recorded.
  
  
  RESULTS
  Semi-quantitative and quantitative CTP ASPECTS were highly correlated (p<0.00001). CBF, CBV and MTT ASPECTS were higher in patients with no HT and mRS ≤ 2 and inversely associated with final infarct volume and mRS (p values: from p<0.05 to p<0.00001). CTP ASPECTS mismatch was slightly associated with radiological and clinical outcomes (p values: from p<0.05 to p<0.02) only if evaluated quantitatively. A CBV ASPECTS of 9 was the optimal semi-quantitative value for predicting outcome.
  
  
  CONCLUSIONS
  Our findings suggest that visual inspection of CTP ASPECTS recognizes infarct and ischemic absolute values. Semi-quantitative CBV ASPECTS, but not CTP ASPECTS mismatch, represents a strong prognostic indicator, implying that core extent is the main determinant of outcome, irrespective of penumbra size.
authors.affiliation: Section of Neurology, Department of Biological, Psychiatric and Psychological Science, University of Ferrara, Ferrara, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Padroni
authors.affiliation: Section of Diagnostic Imaging, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bernardoni
authors.affiliation: Section of Neurology, Department of Biological, Psychiatric and Psychological Science, University of Ferrara, Ferrara, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Tamborino
authors.affiliation: Section of Neurology, Department of Biological, Psychiatric and Psychological Science, University of Ferrara, Ferrara, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Roversi
authors.affiliation: Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Borrelli
authors.affiliation: Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Saletti
authors.affiliation: Neurology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: De Vito
authors.affiliation: Neurology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Azzini
authors.affiliation: Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Borgatti
authors.affiliation: Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
authors.forename: Onofrio
authors.initials: O
authors.lastname: Marcello
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.|Imaging Research Lab, Robarts Research Institute, Western Ontario University, London, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: d'Esterre
authors.affiliation: Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ceruti
authors.affiliation: Section of Neurology, Department of Biological, Psychiatric and Psychological Science, University of Ferrara, Ferrara, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Casetta
authors.affiliation: Imaging Research Lab, Robarts Research Institute, Western Ontario University, London, Ontario, Canada.|Imaging program, Lawson Health Research Institute, Western Ontario University, London, Ontario, Canada.
authors.forename: Ting-Yim
authors.initials: TY
authors.lastname: Lee
authors.affiliation: Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliera Universitaria, Ferrara, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Fainardi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000187:drug effects; D001810:Blood Volume / Q000187:drug effects; D002545:Brain Ischemia / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000187:drug effects; D054022:Cerebrum / Q000098:blood supply / Q000187:drug effects / Q000473:pathology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
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