Article Figures & Data
Figures
- Fig 1.
A 62-year-old man imaged <3 hours after sudden onset of right hemiparesis. From left to right, baseline noncontrast CT (NCCT), CTA source images (CTA-SI), CT perfusion CBV color maps (CT-CBV), and follow-up DWI. Noncontrast CT, by using a window center of 35 HU and a width of 15 HU to visualize optimally the gray-white interface, fails to demonstrate a focal region of parenchymal hypoattenuation, yielding an ASPECTS of 10. CTA source images reveal a focal hypoattenuation at the caudate nucleus consistent with acute infarction, yielding an ASPECTS of 9. CT perfusion CBV map shows relative hypoperfusion in the caudate nucleus as well as at the anterior inferior frontal lobe (M1) and anterior superior frontal lobe (M4), yielding an ASPECTS of 7. Follow-up DWI at 37 hours post-CT imaging confirms acute infarctions in the caudate nucleus, M1, and M4, yielding a final ASPECTS of 7.
- Fig 2.
Plots of linear regression between noncontrast CT (NCCT) ASPECTS (r2 = 0.34, P = .0011), CTA source images (CTA-SI) ASPECTS (r2 = 0.42, P = .0002), and CT perfusion CBV (CT-CBV) ASPECTS (r2 = 0.91, P < .0001), with follow-up DWI ASPECTS.
Tables
- Table 1:
Sensitivity, specificity, and accuracy of detecting ASPECTS regional infarctions <3 hours old (n = 280) with a follow-up DWI reference standard*
Imaging TP FP FN TN Sensitivity Specificity Accuracy NCCT 44 0 58 180 44.0 [28.5–56.1] 100 [97.3–100] 80.0 [73.3–85.4] CTA-SI 57 1 43 179 57.0 [41.4–68.1] 99.4 [96.3–99.9] 84.3 [77.7–89.2] CT-CBV 91 0 9 180 91.0†‡ [83.5–95.3] 100 [97.3–100] 96.8†‡ [94.1–98.3] Note:—NCCT indicates noncontrast CT; CTA-SI, CT angiography source image; CT-CBV, CT perfusion cerebral blood volume maps; TP, true-positive; FP, false-positive; FN, false-negative; TN, true-negative.
* Sensitivity, specificity, and accuracy values are expressed in percentages with 95% CIs in brackets.
† Significantly different compared with NCCT.
‡ Significantly different compared with CTA-SI.
- Table 2:
Comparison of mean NCCT, CTA-SI, CT-CBV, and follow-up DWI ASPECTS (repeated measures ANOVA with the Bonferroni multiple comparisons test)*
NCCT CTA-SI CT-CBV DWI Mean Score (SD) 8.4 (1.8) 8.0 (1.8) 6.8 (1.9) 6.5 (1.8) NCCT [−0.23–1.2]‡ [0.95–2.3]† [1.3–2.7]† CTA-SI [0.49–1.9]† [0.81–2.2]† CT-CBV [−0.37–1.0]‡ Note:—NCCT indicates noncontrast CT; CTA-SI, CT angiography source images; CT-CBV, CT perfusion cerebral blood volume maps; ANOVA, analysis of variance.
* 95% CIs of the difference in mean ASPECTSs are in brackets.
† Significant P value <.05.
‡ Not significant.
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