title: CBV_ASPECTS Improvement over CT_ASPECTS on Determining Irreversible Ischemic Lesion Decreases over Time.
abstract: The Alberta Stroke Program Early CT Score (ASPECTS) is a useful scoring system for assessing early ischemic signs on noncontrast computed tomography (CT). Cerebral blood volume (CBV) on CT perfusion defines the core lesion assumed to be irreversibly damaged. We aim to explore the advantages of CBV_ASPECTS over CT_ASPECTS in the prediction of final infarct volume according to time.
  
  
  METHODS
  Consecutive patients with anterior circulation stroke who underwent endovascular reperfusion according to initial CT_ASPECTS ≥7 were studied. CBV_ASPECTS was assessed blindly later on. Recanalization was defined as thrombolysis in cerebral ischemia score 2b-3. Final infarct volumes were measured on follow-up imaging. We compared ASPECTS on CBV and CT images, and defined ASPECTS agreement as: CT_ASPECTS - CBV_ASPECTS ≤1.
  
  
  RESULTS
  Sixty-five patients, with a mean age of 67 ± 14 years and a median National Institutes of Health Stroke Scale score of 16 (range 10-20), were studied. The recanalization rate was 78.5%. The median CT_ASPECTS was 9 (range 8-10), and the CBV_ASPECTS was 8 (range 8-10). The mean time from symptoms to CT was 219 ± 143 min. Fifty patients (76.9%) showed ASPECTS agreement. The ASPECTS difference was inversely correlated to the time from symptoms to CT (r = -0.36, p < 0.01). A ROC curve defined 120 min as the best cutoff point after which the ASPECTS difference becomes more frequently ≤1. After 120 min, 89.5% of the patients showed ASPECTS agreement (as compared with 37.5% for <120 min, p < 0.01). CBV_ASPECTS but not CT_ASPECTS correlated with final infarct (r = -0.33, p < 0.01). However, if CT was done >2 h after symptom onset, CT_ASPECTS also correlated to final infarct (r = -0.39, p = 0.01).
  
  
  CONCLUSIONS
  In acute stroke, CBV_ASPECTS correlates with the final infarct volume. However, when CT is performed after 120 min from symptom onset, CBV_ASPECTS does not add relevant information to CT_ASPECTS.
authors: Section of Neurology, Department of Biological, Psychiatric and Psychological Science, University of Ferrara, Ferrara, Italy.
authors: Marina
authors: M
authors: Padroni
authors: Stroke Unit, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors: Sandra
authors: S
authors: Boned
authors: Stroke Unit, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors: Marc
authors: M
authors: Ribó
authors: Stroke Unit, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors: Marian
authors: M
authors: Muchada
authors: Stroke Unit, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors: David
authors: D
authors: Rodriguez-Luna
authors: Neuroradiology Unit, Hospital Universitari Vall D'Hebron, Barcelona, Spain.
authors: Pilar
authors: P
authors: Coscojuela
authors: Neuroradiology Unit, Hospital Universitari Vall D'Hebron, Barcelona, Spain.
authors: Alejandro
authors: A
authors: Tomasello
authors: Neuroradiology Unit, Hospital Universitari Vall D'Hebron, Barcelona, Spain.
authors: Jordi
authors: J
authors: Cabero
authors: Stroke Unit, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors: Jorge
authors: J
authors: Pagola
authors: Stroke Unit, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors: Noelia
authors: N
authors: Rodriguez-Villatoro
authors: Stroke Unit, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors: Jesus M
authors: JM
authors: Juega
authors: Stroke Unit, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors: Estela
authors: E
authors: Sanjuan
authors: Stroke Unit, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors: Carlos A
authors: CA
authors: Molina
authors: Stroke Unit, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors: Marta
authors: M
authors: Rubiera
keywords: Computed tomography; Computed tomography perfusion; Stroke; Thrombectomy