Validity of acute stroke lesion volume estimation by diffusion-weighted imaging-Alberta stroke program early computed tomographic score depends on lesion location in 496 patients with middle cerebral artery stroke

Julian Schröder, Bastian Cheng, Martin Ebinger, Martin Köhrmann, Ona Wu, Dong Wha Kang, David S. Liebeskind, Thomas Tourdias, Oliver C. Singer, Soren Christensen, Bruce Campbell, Marie Luby, Steven Warach, Jens Fiehler, Jochen B. Fiebach, Christian Gerloff, Götz Thomalla, Gregory Albers, Stephen Davis, Geoffrey DonnanMarc Fisher, Anthony Furlan, James Grotta, Werner Hacke, Chelsea Kidwell, Walter Koroshetz, Kennedy R. Lees, Michael Lev, A. Gregory Sorensen, Vincent Thijs, Joanna Wardlaw, Max Wintermark Götz Thomalla, Qing Hao, Jong S. Kim, Lorenz Breuer, Andras Treszl, Nils D. Forkert, Ivana Galinovic, Michael Rosenkranz, Tobias Engelhorn, Matthias Endres, Vincent Dousset

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

Background and Purpose - Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) has been used to estimate diffusion-weighted imaging (DWI) lesion volume in acute stroke. We aimed to assess correlations of DWIASPECTS with lesion volume in different middle cerebral artery (MCA) subregions and reproduce existing ASPECTS thresholds of a malignant profile defined by lesion volume =100 mL.

Methods - We analyzed data of patients with MCA stroke from a prospective observational study of DWI and fluidattenuated inversion recovery in acute stroke. DWI-ASPECTS and lesion volume were calculated. The population was divided into subgroups based on lesion localization (superficial MCA territory, deep MCA territory, or both). Correlation of ASPECTS and infarct volume was calculated, and receiver-operating characteristics curve analysis was performed to identify the optimal ASPECTS threshold for =100-mL lesion volume.

Results - A total of 496 patients were included. There was a significant negative correlation between ASPECTS and DWI lesion volume (r=-0.78; P<0.0001). With regards to lesion localization, correlation was weaker in deep MCA region (r=-0.19; P=0.038) when compared with superficial (r=-0.72; P<0.001) or combined superficial and deep MCA lesions (r=-0.72; P<0.001). Receiver-operating characteristics analysis revealed ASPECTS=6 as best cutoff to identify =100-mL DWI lesion volume; however, positive predictive value was low (0.35).

Conclusions - ASPECTS has limitations when lesion location is not considered. Identification of patients with malignant profile by DWI-ASPECTS may be unreliable. ASPECTS may be a useful tool for the evaluation of noncontrast computed tomography. However, if MRI is used, ASPECTS seems dispensable because lesion volume can easily be quantified on DWI maps.

Original languageEnglish (US)
Pages (from-to)3583-3588
Number of pages6
JournalStroke
Volume45
Issue number12
DOIs
StatePublished - Dec 11 2014

Keywords

  • Brain ischemia
  • Diffusion magnetic resonance imaging
  • Magnetic resonance imaging
  • Middle cerebral artery
  • Neuroimaging
  • Severity of illness index
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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