ASPECTS and Other Neuroimaging Scores in the Triage and Prediction of Outcome in Acute Stroke Patients

Neuroimaging Clinics of North America

Volumn 21, Issue 2, 2011, Pages 407-423

  Menon, Bijoy K ^a   Puetz, Volker ^b   Kochar, Puneet ^a   Demchuk, Andrew M ^a  

^a UNIVERSITY OF CALGARY   (Canada)

^b UNIVERSITY HOSPITAL CARL GUSTAV CARUS   (Germany)

Author keywords

Acute stroke; ASPECTS; Intra arterial thrombolysis; Neuroimaging scores

Indexed keywords

ALTEPLASE; PLACEBO; PROUROKINASE; TISSUE PLASMINOGEN ACTIVATOR;

ACUTE DISEASE; ALBERTA STROKE PROGRAM EARLY CT SCORE; BLOOD CLOT LYSIS; BOSTON ACUTE STROKE IMAGING SCALE; BRAIN HEMORRHAGE; BRAIN INFARCTION; BRAIN INFARCTION SIZE; BRAIN ISCHEMIA; CLINICAL DECISION MAKING; CLINICAL TRIAL (TOPIC); CLOT BURDEN SCORE; COMBINATION CHEMOTHERAPY; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; COMPUTER ASSISTED TOMOGRAPHY; DIFFUSION WEIGHTED IMAGING; DISEASE SEVERITY; EMERGENCY HEALTH SERVICE; GREATER THAN 6 HOURS TIME WINDOW; HUMAN; LEPTOMENINGEAL COLLATERAL SCORES ON CTA; LESS THAN 3 HOURS TIME WINDOW; METHODOLOGY; MONOTHERAPY; NEUROIMAGING; NUCLEAR MAGNETIC RESONANCE IMAGING; OUTCOME ASSESSMENT; PATHOPHYSIOLOGY; PATIENT SELECTION; PERFUSION WEIGHTED IMAGING; PONS MIDBRAIN INDEX; POSTERIOR CIRCULATION ALBERTA STROKE PROGRAM EARLY CT SCORE; PREDICTION; PRIORITY JOURNAL; PROGNOSIS; RECANALIZATION; RELIABILITY; REVIEW; RISK FACTOR; SCORING SYSTEM; SENSITIVITY AND SPECIFICITY; STROKE; STROKE PATIENT; THREE TO 6 HOURS TIME WINDOW; TRAINING; TREATMENT RESPONSE;

CEREBRAL ANGIOGRAPHY; HUMANS; IMAGE INTERPRETATION, COMPUTER-ASSISTED; OUTCOME ASSESSMENT (HEALTH CARE); SEVERITY OF ILLNESS INDEX; STROKE; TRIAGE;

EID: 79957819588     PISSN: 10525149     EISSN: 15579867     Source Type: Journal    
DOI: 10.1016/j.nic.2011.01.007     Document Type: Review

References (87)

1. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995, 333(24):1581-1587.
2. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. The NINDS t-PA Stroke Study Group. Stroke 1997, 28(11):2109-2118.
3. Patel S.C., Levine S.R., Tilley B.C., et al. Lack of clinical significance of early ischemic changes on computed tomography in acute stroke. JAMA 2001, 286(22):2830-2838.
4. Hacke W., Kaste M., Fieschi C., et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995, 274(13):1017-1025.
5. von Kummer R., Allen K.L., Holle R., et al. Acute stroke: usefulness of early CT findings before thrombolytic therapy. Radiology 1997, 205(2):327-333.
6. Larrue V., von Kummer R.R., Muller A., et al. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian Acute Stroke Study (ECASS II). Stroke 2001, 32(2):438-441.
7. Grotta J.C., Chiu D., Lu M., et al. Agreement and variability in the interpretation of early CT changes in stroke patients qualifying for intravenous rtPA therapy. Stroke 1999, 30(8):1528-1533.
8. Wardlaw J.M., Dorman P.J., Lewis S.C., et al. Can stroke physicians and neuroradiologists identify signs of early cerebral infarction on CT?. J Neurol Neurosurg Psychiatry 1999, 67(5):651-653.
9. Butcher K.S., Lee S.B., Parsons M.W., et al. Differential prognosis of isolated cortical swelling and hypoattenuation on CT in acute stroke. Stroke 2007, 38(3):941-947.
10. Demchuk A.M., Hill M.D., Barber P.A., et al. Importance of early ischemic computed tomography changes using ASPECTS in NINDS rtPA Stroke Study. Stroke 2005, 36(10):2110-2115.
11. Puetz V., Dzialowski I., Hill M.D., et al. The Alberta Stroke Program Early CT Score in clinical practice: what have we learned?. Int J Stroke 2009, 4(5):354-364.
12. Barber P.A., Demchuk A.M., Zhang J., et al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet 2000, 355(9216):1670-1674.
13. Molina C.A., Alexandrov A.V., Demchuk A.M., et al. Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator. Stroke 2004, 35(1):151-156.
14. Tsivgoulis G., Saqqur M., Sharma V.K., et al. Association of pretreatment ASPECTS scores with tPA-induced arterial recanalization in acute middle cerebral artery occlusion. J Neuroimaging 2008, 18(1):56-61.
15. Dzialowski I., Hill M.D., Coutts S.B., et al. Extent of early ischemic changes on computed tomography (CT) before thrombolysis, prognostic value of the Alberta Stroke Program Early CT Score in ECASS II. Stroke 2006, 37(4):973-978.
16. Barber P.A., Hill M.D., Eliasziw M., et al. Imaging of the brain in acute ischaemic stroke: comparison of computed tomography and magnetic resonance diffusion-weighted imaging. J Neurol Neurosurg Psychiatry 2005, 76(11):1528-1533.
17. Hill M.D., Buchan A.M. Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study. CMAJ 2005, 172(10):1307-1312.
18. Weir N.U., Pexman J.H., Hill M.D., et al. How well does ASPECTS predict the outcome of acute stroke treated with IV tPA?. Neurology 2006, 67(3):516-518.
19. Penumbra Pivotal Stroke Trial Investigators The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke 2009, 40(8):2761-2768.
20. Goyal M., Menon B.K., Coutts S.B., et al. Effect of baseline CT scan appearance and time to recanalization on clinical outcomes in endovascular thrombectomy of acute ischemic strokes. Stroke 2010, 42(1):93-97.
21. Hill M.D., Rowley H.A., Adler F., et al. Selection of acute ischemic stroke patients for intra-arterial thrombolysis with pro-urokinase by using ASPECTS. Stroke 2003, 34(8):1925-1931.
22. Furlan A., Higashida R., Wechsler L., et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA 1999, 282(21):2003-2011.
23. Hill M.D., Demchuk A.M., Tomsick T.A., et al. Using the baseline CT scan to select acute stroke patients for IV-IA therapy. AJNR Am J Neuroradiol 2006, 27(8):1612-1616.
24. IMS Study Investigators Combined intravenous and intra-arterial recanalization for acute ischemic stroke: the Interventional Management of Stroke Study. Stroke 2004, 35(4):904-911.
25. Tanne D., Kasner S.E., Demchuk A.M., et al. Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice: the Multicenter rt-PA Stroke Survey. Circulation 2002, 105(14):1679-1685.
26. Lees K.R., Bluhmki E., von Kummer R., et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010, 375(9727):1695-1703.
27. Pexman J.H., Barber P.A., Hill M.D., et al. Use of the Alberta Stroke Program Early CT Score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol 2001, 22(8):1534-1542.
28. Coutts S.B., Demchuk A.M., Barber P.A., et al. Interobserver variation of ASPECTS in real time. Stroke 2004, 35(5):e103-e105.
29. Mak H.K., Yau K.K., Khong P.L., et al. Hypodensity of >1/3 middle cerebral artery territory versus Alberta Stroke Programme Early CT Score (ASPECTS): comparison of two methods of quantitative evaluation of early CT changes in hyperacute ischemic stroke in the community setting. Stroke 2003, 34(5):1194-1196.
30. Kalafut M.A., Schriger D.L., Saver J.L., et al. Detection of early CT signs of >1/3 middle cerebral artery infarctions: interrater reliability and sensitivity of CT interpretation by physicians involved in acute stroke care. Stroke 2000, 31(7):1667-1671.
31. Silver B., Demaerschalk B., Merino J.G., et al. Improved outcomes in stroke thrombolysis with pre-specified imaging criteria. Can J Neurol Sci 2001, 28(2):113-119.
32. Demaerschalk B.M., Silver B., Wong E., et al. ASPECT scoring to estimate >1/3 middle cerebral artery territory infarction. Can J Neurol Sci 2006, 33(2):200-204.
33. Dzialowski I., Weber J., Doerfler A., et al. Brain tissue water uptake after middle cerebral artery occlusion assessed with CT. J Neuroimaging 2004, 14(1):42-48.
34. Schuier F.J., Hossmann K.A. Experimental brain infarcts in cats. II. Ischemic brain edema. Stroke 1980, 11(6):593-601.
35. Dzialowski I., Klotz E., Goericke S., et al. Ischemic brain tissue water content: CT monitoring during middle cerebral artery occlusion and reperfusion in rats. Radiology 2007, 243(3):720-726.
36. Schramm P., Schellinger P.D., Klotz E., et al. Comparison of perfusion computed tomography and computed tomography angiography source images with perfusion-weighted imaging and diffusion-weighted imaging in patients with acute stroke of less than 6 hours' duration. Stroke 2004, 35(7):1652-1658.
37. Lev M.H., Segal A.Z., Farkas J., et al. Utility of perfusion-weighted CT imaging in acute middle cerebral artery stroke treated with intra-arterial thrombolysis: prediction of final infarct volume and clinical outcome. Stroke 2001, 32(9):2021-2028.
38. Camargo E.C., Furie K.L., Singhal A.B., et al. Acute brain infarct: detection and delineation with CT angiographic source images versus nonenhanced CT scans. Radiology 2007, 244(2):541-548.
39. Coutts S.B., Lev M.H., Eliasziw M., et al. ASPECTS on CTA source images versus unenhanced CT: added value in predicting final infarct extent and clinical outcome. Stroke 2004, 35(11):2472-2476.
40. Chalela J.A., Kidwell C.S., Nentwich L.M., et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet 2007, 369(9558):293-298.
41. Kimura K., Iguchi Y., Shibazaki K., et al. Large ischemic lesions on diffusion-weighted imaging done before intravenous tissue plasminogen activator thrombolysis predicts a poor outcome in patients with acute stroke. Stroke 2008, 39(8):2388-2391.
42. Nezu T., Koga M., Kimura K., et al. Pretreatment ASPECTS on DWI predicts 3-month outcome following rt-PA: SAMURAI rt-PA Registry. Neurology 2010, 75(6):555-561.
43. Hill M.D., Menon B.K. Effect modification and ischaemic stroke treatment. Lancet Neurol 2010, 9(7):649-651.
44. Coutts S.B., Simon J.E., Tomanek A.I., et al. Reliability of assessing percentage of diffusion-perfusion mismatch. Stroke 2003, 34(7):1681-1683.
45. Terasawa Y., Kimura K., Iguchi Y., et al. Could clinical diffusion-mismatch determined using DWI ASPECTS predict neurological improvement after thrombolysis before 3 h after acute stroke?. J Neurol Neurosurg Psychiatry 2010, 81(8):864-868.
46. Butcher K., Parsons M., Allport L., et al. Rapid assessment of perfusion-diffusion mismatch. Stroke 2008, 39(1):75-81.
47. Lin K., Rapalino O., Lee B., et al. Correlation of volumetric mismatch and mismatch of Alberta Stroke Program Early CT Scores on CT perfusion maps. Neuroradiology 2009, 51(1):17-23.
48. Parsons M.W., Pepper E.M., Chan V., et al. Perfusion computed tomography: prediction of final infarct extent and stroke outcome. Ann Neurol 2005, 58(5):672-679.
49. Puetz V., Sylaja P.N., Coutts S.B., et al. Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke 2008, 39(9):2485-2490.
50. Schaefer P.W., Yoo A.J., Bell D., et al. CT angiography-source image hypoattenuation predicts clinical outcome in posterior circulation strokes treated with intra-arterial therapy. Stroke 2008, 39(11):3107-3109.
51. del Zoppo G.J., Poeck K., Pessin M.S., et al. Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke. Ann Neurol 1992, 32(1):78-86.
52. Saqqur M., Uchino K., Demchuk A.M., et al. Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke. Stroke 2007, 38(3):948-954.
53. Puetz V., Dzialowski I., Hill M.D., et al. Intracranial thrombus extent predicts clinical outcome, final infarct size and hemorrhagic transformation in ischemic stroke: the clot burden score. Int J Stroke 2008, 3(4):230-236.
54. Tan I.Y., Demchuk A.M., Hopyan J., et al. CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. AJNR Am J Neuroradiol 2009, 30(3):525-531.
55. Torres-Mozqueda F., He J., Yeh I.B., et al. An acute ischemic stroke classification instrument that includes CT or MR angiography: the Boston Acute Stroke Imaging Scale. AJNR Am J Neuroradiol 2008, 29(6):1111-1117.
56. Brozici M., van der Zwan A., Hillen B. Anatomy and functionality of leptomeningeal anastomoses: a review. Stroke 2003, 34(11):2750-2762.
57. Liebeskind D.S. Collateral circulation. Stroke 2003, 34(9):2279-2284.
58. Liebeskind D.S. Stroke: the currency of collateral circulation in acute ischemic stroke. Nat Rev Neurol 2009, 5(12):645-646.
59. Duvernoy H.M., Delon S., Vannson J.L. Cortical blood vessels of the human brain. Brain Res Bull 1981, 7(5):519-579.
60. Bang O.Y., Saver J.L., Buck B.H., et al. Impact of collateral flow on tissue fate in acute ischaemic stroke. J Neurol Neurosurg Psychiatry 2008, 79(6):625-629.
61. Miteff F., Levi C.R., Bateman G.A., et al. The independent predictive utility of computed tomography angiographic collateral status in acute ischaemic stroke. Brain 2009, 132(Pt 8):2231-2238.
62. Symon L. Studies of leptomeningeal collateral circulation in Macacus rhesus. J Physiol 1961, 159(1):68-86. 1.
63. Coyle P., Jokelainen P.T. Dorsal cerebral arterial collaterals of the rat. Anat Rec 1982, 203(3):397-404.
64. Reina-De La Torre F., Rodriguez-Baeza A., Sahuquillo-Barris J. Morphological characteristics and distribution pattern of the arterial vessels in human cerebral cortex: a scanning electron microscope study. Anat Rec 1998, 251(1):87-96.
65. Higashida R., Furlan A., Roberts H., et al. Trial design and reporting standards for intraarterial cerebral thrombolysis for acute ischemic stroke. J Vasc Interv Radiol 2003, 14(9 Pt 2):S493-S494.
66. Christoforidis G.A., Mohammad Y., Kehagias D., et al. Angiographic assessment of pial collaterals as a prognostic indicator following intra-arterial thrombolysis for acute ischemic stroke. AJNR Am J Neuroradiol 2005, 26(7):1789-1797.
67. Tan J.C., Dillon W.P., Liu S., et al. Systematic comparison of perfusion-CT and CT-angiography in acute stroke patients. Ann Neurol 2007, 61(6):533-543.
68. Rosenthal E.S., Schwamm L.H., Roccatagliata L., et al. Role of recanalization in acute stroke outcome: rationale for a CT angiogram-based " benefit of recanalization" model. AJNR Am J Neuroradiol 2008, 29(8):1471-1475.
69. Maas M.B., Lev M.H., Ay H., et al. Collateral vessels on CT angiography predict outcome in acute ischemic stroke. Stroke 2009, 40(9):3001-3005.
70. Kim J.J., Fischbein N.J., Lu Y., et al. Regional angiographic grading system for collateral flow: correlation with cerebral infarction in patients with middle cerebral artery occlusion. Stroke 2004, 35(6):1340-1344.
71. Lima F.O., Furie K.L., Silva G.S., et al. The pattern of leptomeningeal collaterals on CT angiography is a strong predictor of long-term functional outcome in stroke patients with large vessel intracranial occlusion. Stroke 2010, 41(10):2316-2322.
72. Tu Y.K., Clerehugh V., Gilthorpe M.S. Collinearity in linear regression is a serious problem in oral health research. Eur J Oral Sci 2004, 112(5):389-397.
73. Xue X., Kim M.Y., Shore R.E. Cox regression analysis in presence of collinearity: an application to assessment of health risks associated with occupational radiation exposure. Lifetime Data Anal 2007, 13(3):333-350.
74. Puetz V., Dzialowski I., Hill M.D., et al. Malignant profile detected by CT angiographic information predicts poor prognosis despite thrombolysis within three hours from symptom onset. Cerebrovasc Dis 2010, 29(6):584-591.
75. Nabavi D.G., Kloska S.P., Nam E.M., et al. MOSAIC: Multimodal Stroke Assessment Using Computed Tomography: novel diagnostic approach for the prediction of infarction size and clinical outcome. Stroke 2002, 33(12):2819-2826.
76. Krieger D.W., Demchuk A.M., Kasner S.E., et al. Early clinical and radiological predictors of fatal brain swelling in ischemic stroke. Stroke 1999, 30(2):287-292.
77. Barber P.A., Demchuk A.M., Hudon M.E., et al. Hyperdense sylvian fissure MCA " dot" sign: a CT marker of acute ischemia. Stroke 2001, 32(1):84-88.
78. Tomsick T.A., Brott T.G., Olinger C.P., et al. Hyperdense middle cerebral artery: incidence and quantitative significance. Neuroradiology 1989, 31(4):312-315.
79. Lee K.Y., Han S.W., Kim S.H., et al. Early recanalization after intravenous administration of recombinant tissue plasminogen activator as assessed by pre- and post-thrombolytic angiography in acute ischemic stroke patients. Stroke 2007, 38(1):192-193.
80. Sims J.R., Rordorf G., Smith E.E., et al. Arterial occlusion revealed by CT angiography predicts NIH stroke score and acute outcomes after IV tPA treatment. AJNR Am J Neuroradiol 2005, 26(2):246-251.
81. Khatri P., Hill M.D., Palesch Y.Y., et al. Methodology of the interventional management of stroke III trial. Int J Stroke 2008, 3(2):130-137.
82. Baron J.C., von Kummer R., del Zoppo G.J. Treatment of acute ischemic stroke. Challenging the concept of a rigid and universal time window. Stroke 1995, 26(12):2219-2221.
83. Schellinger P.D. EPITHET: failed chance or new hope?. Lancet Neurol 2008, 7(4):286-287.
84. Coutts S.B., Hill M.D., Demchuk A.M., et al. ASPECTS reading requires training and experience. Stroke 2003, 34(10):e179. [author reply: e179].
85. Pexman J.H., Hill M.D., Buchan A.M., et al. Hyperacute stroke: experience essential when reading unenhanced CT scans. AJNR Am J Neuroradiol 2004, 25(3):516. [author reply: 516-8].
86. von Kummer R. Effect of training in reading CT scans on patient selection for ECASS II. Neurology 1998, 51(3 Suppl 3):S50-S52.
87. Wardlaw J.M., Mielke O. Early signs of brain infarction at CT: observer reliability and outcome after thrombolytic treatment-systematic review. Radiology 2005, 235(2):444-453.