title: Performance of CT ASPECTS and Collateral Score in Risk Stratification: Can Target Perfusion Profiles Be Predicted without Perfusion Imaging?
abstract: Endovascular trials suggest that revascularization benefits a subset of acute ischemic stroke patients with large-artery occlusion and small-core infarct volumes. The objective of our study was to identify thresholds of noncontrast CT-ASPECTS and collateral scores on CT angiography that best predict ischemic core volume thresholds quantified by CT perfusion among patients with acute ischemic stroke.
  
  
  
  Fifty-four patients with acute ischemic stroke (<12 hours) and MCA/intracranial ICA occlusion underwent NCCT/CTP during their initial evaluation. CTP analysis was performed on a user-independent platform (RApid processing of PerfusIon and Diffusion), computing core infarct (defined as CBF of <30% normal). A target mismatch profile consisting of infarction core of ≤50 mL was selected to define candidates with acute ischemic stroke likely to benefit from revascularization.
  
  
  
  NCCT-ASPECTS of ≥9 with a CTA collateral score of 3 had 100% specificity for identifying patients with a CBF core volume of ≤50 mL. NCCT-ASPECTS of ≤6 had 100% specificity for identifying patients with a CBF core volume of >50 mL. In our cohort, 44 (81%) patients had an NCCT-ASPECTS of ≥9, a CTA collateral score of 3, or an NCCT-ASPECTS of ≤6.
  
  
  
  Using an NCCT-ASPECTS of ≥9 or a CTA collateral score of 3 best predicts CBF core volume infarct of ≤50 mL, while an NCCT-ASPECTS of ≤6 best predicts a CBF core volume infarct of >50 mL. Together these thresholds suggest that a specific population of patients with acute ischemic stroke not meeting such profiles may benefit most from CTP imaging to determine candidacy for revascularization.
authors.affiliation: From the Departments of Radiology and Imaging Sciences (S.D., M.B., J.W.A., T.G.) Neurology (S.D., J.W.A., S.R., C.B., F.N.), Emory University Hospital, Atlanta, Georgia Seena.Dehkharghani@Emory.edu.
authors.forename: S
authors.identifier: 0000-0002-3141-1094
authors.initials: S
authors.lastname: Dehkharghani
authors.affiliation: Department of Radiology (R.B.), Stanford University Hospital, Stanford, California.
authors.forename: R
authors.identifier: 0000-0002-9509-5772
authors.initials: R
authors.lastname: Bammer
authors.affiliation: Institut für Radiologie und Nuklearmedizin (M.S.), Kantonsspital Winterthur, Winterthur, Switzerland.
authors.forename: M
authors.identifier: 0000-0002-5924-0047
authors.initials: M
authors.lastname: Straka
authors.affiliation: From the Departments of Radiology and Imaging Sciences (S.D., M.B., J.W.A., T.G.).
authors.forename: M
authors.identifier: 0000-0003-2245-7418
authors.initials: M
authors.lastname: Bowen
authors.affiliation: From the Departments of Radiology and Imaging Sciences (S.D., M.B., J.W.A., T.G.) Neurology (S.D., J.W.A., S.R., C.B., F.N.), Emory University Hospital, Atlanta, Georgia.
authors.forename: J W
authors.identifier: 0000-0002-5274-1105
authors.initials: JW
authors.lastname: Allen
authors.affiliation: Neurology (S.D., J.W.A., S.R., C.B., F.N.), Emory University Hospital, Atlanta, Georgia.
authors.forename: S
authors.identifier: 0000-0003-2765-1500
authors.initials: S
authors.lastname: Rangaraju
authors.affiliation: Department of Biostatistics (J.K.), University of Michigan, Ann Arbor, Michigan.
authors.forename: J
authors.identifier: 0000-0002-5643-2668
authors.initials: J
authors.lastname: Kang
authors.affiliation: From the Departments of Radiology and Imaging Sciences (S.D., M.B., J.W.A., T.G.).
authors.forename: T
authors.identifier: 0000-0003-0752-8329
authors.initials: T
authors.lastname: Gleason
authors.affiliation: Neurology (S.D., J.W.A., S.R., C.B., F.N.), Emory University Hospital, Atlanta, Georgia.
authors.forename: C
authors.identifier: 0000-0002-2780-8507
authors.initials: C
authors.lastname: Brasher
authors.affiliation: Neurology (S.D., J.W.A., S.R., C.B., F.N.), Emory University Hospital, Atlanta, Georgia.
authors.forename: F
authors.identifier: 0000-0003-1710-9881
authors.initials: F
authors.lastname: Nahab
mesh_terms: D002533:Cerebral Angiography / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000379:methods*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D055420:Perfusion Imaging; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging*