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Research ArticleAdult Brain
Open Access

Correlation between ASPECTS and Core Volume on CT Perfusion: Impact of Time since Stroke Onset and Presence of Large-Vessel Occlusion

S. Nannoni, F. Ricciardi, D. Strambo, G. Sirimarco, M. Wintermark, V. Dunet and P. Michel
American Journal of Neuroradiology March 2021, 42 (3) 422-428; DOI: https://doi.org/10.3174/ajnr.A6959
S. Nannoni
aFrom the Stroke Center (S.N., D.S., G.S., P.M.), Neurology Service
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F. Ricciardi
cDepartment of Statistical Science (F.R.), University College London, London, UK
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D. Strambo
aFrom the Stroke Center (S.N., D.S., G.S., P.M.), Neurology Service
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G. Sirimarco
aFrom the Stroke Center (S.N., D.S., G.S., P.M.), Neurology Service
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M. Wintermark
dDepartment of Radiology (M.W.), Neuroradiology Division, Stanford University and Medical Center, Stanford, California
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V. Dunet
bDepartment of Diagnostic and Interventional Radiology (V.D.), Lausanne University Hospital, Lausanne, Switzerland
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P. Michel
aFrom the Stroke Center (S.N., D.S., G.S., P.M.), Neurology Service
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Abstract

BACKGROUND AND PURPOSE: Both ASPECTS and core volume on CTP are used to estimate infarct volume in acute ischemic stroke. To evaluate the potential role of ASPECTS for acute endovascular treatment decisions, we studied the correlation between ASPECTS and CTP core, depending on the timing and the presence of large-vessel occlusion.

MATERIALS AND METHODS: We retrospectively reviewed all MCA acute ischemic strokes with standardized reconstructions of CTP maps entered in the Acute STroke Registry and Analysis of Lausanne (ASTRAL) registry. Correlation between ASPECTS and CTP core was determined for early (<6 hours) versus late (6–24 hours) times from stroke onset and in the presence versus absence of large-vessel occlusion. We used correlation coefficients and adjusted multiple linear regression models.

RESULTS: We included 1046 patients with a median age of 71.4 years (interquartile range, IQR = 59.8–79.4 years), an NIHSS score of 12 (IQR, 6–18), an ASPECTS of 9 (IQR, 7–10), and a CTP core of 13.6 mL (IQR, 0.6–52.8 mL). The overall correlation between ASPECTS and CTP core was moderate (ρ = –0.49, P < .01) but significantly stronger in the late-versus-early window (ρ = –0.56 and ρ = –0.48, respectively; P = .05) and in the presence versus absence of large-vessel occlusion (ρ = –0.40 and ρ = –0.20, respectively; P < .01). In the regression model, the independent association between ASPECTS and CTP core was confirmed and was twice as strong in late-arriving patients with large-vessel occlusion (β = –0.21 per 10 mL; 95% CI, −0.27 to –0.15; P < .01) than in the overall population (β = –0.10; 95% CI, −0.14 to –0.07; P < .01).

CONCLUSIONS: In a large cohort of patients with acute ischemic stroke, we found a moderate correlation between ASPECTS and CTP core. However, this was stronger in patients with large-vessel occlusion and longer delay from stroke onset. Our results could support the use of ASPECTS as a surrogate marker of CTP core in late-arriving patients with acute ischemic stroke with large-vessel occlusion.

ABBREVIATIONS:

AIS
acute ischemic stroke
ASTRAL
Acute STroke Registry and Analysis of Lausanne
CBS
clot burden score
CTP
Computed tomographic perfusion
EVT
endovascular treatment
LPGH
last proof of good health
LVO
large-vessel occlusion
MCA
middle cerebral artery
NCCT
non-contrast CT scan
  • © 2021 by American Journal of Neuroradiology

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American Journal of Neuroradiology: 42 (3)
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Cite this article
S. Nannoni, F. Ricciardi, D. Strambo, G. Sirimarco, M. Wintermark, V. Dunet, P. Michel
Correlation between ASPECTS and Core Volume on CT Perfusion: Impact of Time since Stroke Onset and Presence of Large-Vessel Occlusion
American Journal of Neuroradiology Mar 2021, 42 (3) 422-428; DOI: 10.3174/ajnr.A6959

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Correlation between ASPECTS and Core Volume on CT Perfusion: Impact of Time since Stroke Onset and Presence of Large-Vessel Occlusion
S. Nannoni, F. Ricciardi, D. Strambo, G. Sirimarco, M. Wintermark, V. Dunet, P. Michel
American Journal of Neuroradiology Mar 2021, 42 (3) 422-428; DOI: 10.3174/ajnr.A6959
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