Abstract
Purpose
The aim of the study was to compare the assessment of ischemic changes by expert reading
and available automated software for non-contrast CT (NCCT) and CT perfusion on baseline
multimodal imaging and demonstrate the accuracy for the final infarct prediction.
Methods
Early ischemic changes were measured by ASPECTS on the baseline neuroimaging of consecutive
patients with anterior circulation ischemic stroke. The presence of early ischemic
changes was assessed a) on NCCT by two experienced raters, b) on NCCT by e-ASPECTS,
and c) visually on derived CT perfusion maps (CBF<30%, Tmax>10s). Accuracy was calculated
by comparing presence of final ischemic changes on 24-hour follow-up for each ASPECTS
region and expressed as sensitivity, specificity, positive predictive value (PPV),
and negative predictive value (NPV). The subanalysis for patients with successful
recanalization was conducted.
Results
Of 263 patients, 81 fulfilled inclusion criteria. Median baseline ASPECTS was 9 for
all tested modalities. Accuracy was 0.76 for e-ASPECTS, 0.79 for consensus, 0.82 for
CBF<30%, 0.80 for Tmax>10s. e-ASPECTS, consensus, CBF<30%, and Tmax>10s had sensitivity
0.41, 0.46, 0.49, 0.57, respectively; specificity 0.91, 0.93, 0.95, 0.91, respectively;
PPV 0.66, 0.75, 0.82, 0.73, respectively; NPV 0.78, 0.80, 0.82, 0.83, respectively.
Results did not differ in patients with and without successful recanalization.
Conclusion
This study demonstrated high accuracy for the assessment of ischemic changes by different
CT modalities with the best accuracy for CBF<30% and Tmax>10s. The use of automated
software has a potential to improve the detection of ischemic changes.
Keywords
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Article info
Publication history
Accepted:
May 17,
2020
Received in revised form:
April 29,
2020
Received:
January 24,
2020
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104978
Copyright
© 2020 Elsevier Inc. All rights reserved.
