Estimation of ischemic core in acute ischemic stroke with CT angiography and non-contrast CT: Attenuation changes in ASPECTS regions vs. automated ASPECTS scoring

作者全名："Li, Jing; Peng, Yuling; Liu, Jiayang; Wu, Jiajing; Yao, Yunzhuo; Gu, Sirun; Zhang, Zhiwei; Li, Yi; Wang, Jingjie; Li, Yongmei"

作者地址："[Li, Jing; Peng, Yuling; Liu, Jiayang; Wu, Jiajing; Yao, Yunzhuo; Gu, Sirun; Zhang, Zhiwei; Wang, Jingjie; Li, Yongmei] Chongqing Med Univ, Affiliated Hosp 1, Dept Radiol, Chongqing, Peoples R China; [Li, Jing] Cent Hosp Shaoyang, Med Imaging Ctr, Shaoyang, Peoples R China; [Li, Yi] Neusoft Res Intelligent Healthcare Technol Co Ltd, Artificial Intelligence & Clin Innovat Res, Shanghai, Peoples R China"

通信作者："Wang, JJ; Li, YM (通讯作者)，Chongqing Med Univ, Affiliated Hosp 1, Dept Radiol, Chongqing, Peoples R China."

来源：FRONTIERS IN NEUROSCIENCE

ESI学科分类：NEUROSCIENCE & BEHAVIOR

WOS号：WOS:000891347800001

JCR分区：Q2

影响因子：4.3

年份：2022

卷号：16

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：ischemic stroke; reperfusion therapy; Alberta Stroke Program Early CT Score; non-contrast CT; CTA source images; perfusion imaging; ischemic core

摘要："PurposeReperfusion therapies for acute ischemic stroke due to large-vessel occlusion (AIS-LVO) are highly time-dependent, and large infarction is related to poor outcomes and risk of symptomatic hemorrhage. It is of significance to investigate and optimize the screening means and selection criteria for reperfusion therapies to identify more appropriate patients with better outcomes. This study aimed to compare the performance of attenuation changes vs. automated Alberta Stroke Program Early CT Score (ASPECTS) and using CT angiography (CTA) source images vs. non-contrast CT (NCCT) in distinguishing the infarction extent of ischemic core volumes >= 70 ml within different time windows. MethodsA total of 73 patients with AIS-LVO who received multimodal CT were analyzed. The automated software was used to calculate ASPECTS. Attenuation change was defined as the sum of products of relative Hounsfield unit (rHU) values times weighting factors of all 10 ASPECTS regions. rHU value of each region was the HU of the ischemic side over that of the contralateral. The corresponding weighting factors were the regression coefficients derived from a multivariable linear regression model which was used to correlate regional rHU with ischemic core volumes, because each region in the ASPECTS template is weighted disproportionally in the ASPECTS system. Automated ASPECTS and attenuation changes were both calculated using CTA and NCCT, respectively. ResultsAttenuation changes were correlated with ischemic core volumes within different time windows (Rho ranging from 0.439 to 0.637). In classification of the ischemic core >= 70 ml, the performances of attenuation changes were comparable with ASPECTS (area under the curve [AUC] ranging from 0.799 to 0.891), with DeLong's test (P = 0.079, P = 0.373); using CTA (AUC = 0.842) was not different from NCCT (AUC = 0.838). ConclusionAttenuation changes in ASPECTS regions were correlated with ischemic core volumes. In the classification of infarction volumes, attenuation changes had a high diagnostic ability comparable with automated ASPECTS. Measurement of attenuation changes is not involved in complicated scoring algorithms. This measurement can be used as an available, rapid, reliable, and accurate means to evaluate infarction extent within different time windows. The usefulness of infarction volumes measured by attenuation changes to identify more appropriate patients for reperfusion therapies can be validated in future clinical trials."

基金机构：Research Project of Health Committee of Hunan Province; Key Project of Technological Innovation and Application Development of Chongqing Science and Technology Bureau; [202209013170]; [CSTC2021 jscx-gksb-N0008]

基金资助正文：Funding This study was funded by the Research Project of Health Committee of Hunan Province (202209013170) and the Key Project of Technological Innovation and Application Development of Chongqing Science and Technology Bureau (CSTC2021 jscx-gksb-N0008).