Article Figures & Data
Figures
- Fig 1.
Scatterplot of pc-ASPECTS scores on CTASI and NCCT compared with the pc-ASPECTS score on follow-up images. Larger symbols represent a larger number of patients at each data point. The estimated lines are derived from simple linear regression equations. CTASI (R2 = 0.58, p < 0.001; slope = 0.68) results in lower variance around the point estimate of the slope of the line compared with NCCT. (R2 = 0.13, p = 0.02; slope = 0.18).
- Fig 2.
Comparison of median baseline pc-ASPECTS scores on NCCT and CTASI according to categorized follow-up pc-ASPECTS scores (box-whisker plot). Follow-up pc-ASPECTS category 0 to 3 indicates large, 4 to 7 medium-sized, and 8 to 10 small final infarct size.
- Fig 3.
The pc-ASPECTS score on NCCT (A,D) was rated as 8 (early ischemic changes left mesencephalon; arrow). CTASI (B,E) demonstrate additional hypoattenuation in the left thalamus (arrows). The pc-ASPECTS score was rated as 7. On follow-up NCCT (C,F), the patient had PH with intraventricular hemorrhage. The follow-up pc-ASPECTS score was rated as 7 (mesencephalon and left thalamus).
Tables
- Table 1:
Sensitivity and specificity of CTASI compared with NCCT to identify subsequent infarction on follow-up images in individual pc-ASPECTS regions
Pc-ASPECTS Region CTASI NCCT Sensitivity (95% CI) Specificity (95% CI) Sensitivity (95% CI) Specificity (95% CI) All pc-ASPECTS regions 35 (29–43)* 98 (95–99) 18 (13–25) 94 (89–96) Categorization by recanalization status Recanalization ≤ 24 hours 34 (25–44) 96 (90–99) 18 (12–28) 93 (86–97) No recanalization ≤ 24 hours 58 (39–74)* 100 (91–100) 15 (6–33) 86 (76–93) Recanalization status not assessed 25 (14–40) 99 (91–100) 21 (11–35) 91 (84–95) Individual regions Midbrain 59 (41–76) 96 (85–99) 26 (14–45) 98 (88–100) Pons 38 (23–56)* 96 (84–99) 6 (1–22) 98 (87–100) Thalamus 37 (21–56) 98 (88–100) 17 (6–35) 88 (75–95) Cerebellum 32 (20–47) 100 (86–100) 26 (15–41) 100 (85–100) PCA 17 (7–35) 100 (90–100) 18 (7–35) 87 (73–95) Note:—Pc-ASPECTS indicates posterior circulation Acute Stroke Prognosis Early CT Score; CTASI, CT angiography source images; NCCT; noncontrast CT; PCA, posterior cerebral artery.
* Indicates results where 95% confidence intervals for CTASI and NCCT do not overlap.
- Table 2:
Percentages of patients with infarct extension (ie, lower pc-ASPECTS score on follow-up images compared with the pc-ASPECTS score on CTASI) categorized by the recanalization status
Parameter Recanalization ≤ 24 Hours P No Yes Not Assessed Number of patients, n 9 21 13 − Patients with infarct extension, n (%) 6 (67) 18 (86) 10 (77) .43 Infarct extension in individual pc-ASPECTS regions* Pons, n (%) 2 (22) 7 (33) 4 (21) .91 Midbrain, n (%) 0 (0) 6 (29) 3 (23) .29 Thalamus, n/N (%) 2/18 (11) 10/42 7/26 (27) .47 PCA, n/N (%) 3/18 (17) 16/42 (38) 8/26 (31) .29 Cerebellum, n/N (%) 3/18 (17) 23/42 (55) 7/26 (27) .008 * Infarct extension in individual pc-ASPECTS regions indicates infarction on follow-up images that was not diagnosed on CTASI.
- Table 3:
Pc-ASPECTS on follow-up images and HT rates for categorized CTASI pc-ASPECTS groups
Outcome CTASI pc-ASPECTS Risk Ratio (95% CI) P value 8–10 0–7 All patients, N 21 22 F/U pc-ASPECTS score, median (range) 7 (3–10) 3.5 (0–9) − < .001 HT, % (n) 9.5 (2) 27.3 (6) 0.4 (0.1–1.5) .24 PH, % (n) 4.8 (1) 18.2 (4) 0.3 (0.03–2.2) .34 HI, % (n) 4.8 (1) 9.1 (2) 0.5 (0.1–5.4) 1.00 Patients with thrombolysis, N 16 19 F/U pc-ASPECTS score, median (range) 7 (3–10) 3 (0–7) − < .001 HT, % (n) 12.5 (2) 31.6 (6) 0.4 (0.1–1.7) .24 PH, % (n) 6.3 (1) 21.1 (4) 0.3 (0.04–2.4) .35 HI, % (n) 6.3 (1) 10.6 (2) 0.6 (0.1–6.0) 1.00 Note:—F/U denotes follow-up; HT, hemorrhagic transformation; PH, parenchymal hematoma; HI, hemorrhagic infarction.
Characteristic HT on Follow-up Image P value Yes No Number, N 8 35 Age (yr), median (range) 61 (42–78) 69 (40–90) .25 History of diabetes, n (%) 2 (25) 7 (20) 1.00 Baseline NIHSS score, median (range) 31 (11–40) 18 (0–40) .005* GCS, median (range) 4 (3–15) 11 (3–15) .012* Onset-to-CTA (hrs), median (range) 6.2 (1–24) 4.6 (0.7–24) .85 Any thrombolysis, n (%) 8 (100) 27 (77) .32 IV lysis, n (%) 8 (100) 20 (57) .036* IA therapy, n (%) 7 (88) 22 (63) .24 Combined IV/IA therapy, n (%) 7 (88) 15 (43) .046* Onset-to-treatment (hrs), median (range) 5.5 (1.9–24) 4.2 (1.9–18.2) .21 Recanalization ≤ 24 hrs, n/N (%) 4/7 (57) 17/23 (74) .33 Pc-ASPECTS score on NCCT, median (range) 8 (5–10) 9 (5–10) .11 Pc-ASPECTS score on CTASI, median (range) 5 (4–10) 8 (0–10) .051** Pc-ASPECTS score on F/U image, median (range) 1.5 (0–7) 6 (0–10) .015* Note:—NIHSS indicates National Institutes of Health Stroke Scale score; GCS, Glasgow Coma Scale score; CTA, CT angiography; IV, intravenous; IA, intra-arterial.
* Indicates results that are statistically significant.
** Indicates results with borderline statistical significance.
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