Observational Study

. 2014 Dec;45(12):3583-8.

doi: 10.1161/STROKEAHA.114.006694. Epub 2014 Oct 14.

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 Schröder¹, Bastian Cheng², Martin Ebinger², Martin Köhrmann², Ona Wu², Dong-Wha Kang², David S Liebeskind², Thomas Tourdias², Oliver C Singer², Soren Christensen², Bruce Campbell², Marie Luby², Steven Warach², Jens Fiehler², Jochen B Fiebach², Christian Gerloff², Götz Thomalla²; STIR and VISTA Imaging Investigators

Collaborators, Affiliations

Collaborators

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

Affiliations

¹ From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.). jul.schroeder@uke.de.
² From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.).

PMID: 25316278
PMCID: PMC4749150
DOI: 10.1161/STROKEAHA.114.006694

Observational Study

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 et al. Stroke. 2014 Dec.

. 2014 Dec;45(12):3583-8.

doi: 10.1161/STROKEAHA.114.006694. Epub 2014 Oct 14.

Authors

Collaborators

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

Affiliations

¹ From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.). jul.schroeder@uke.de.
² From the Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.).

PMID: 25316278
PMCID: PMC4749150
DOI: 10.1161/STROKEAHA.114.006694

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 DWI-ASPECTS 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 fluid-attenuated 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.

Keywords: brain ischemia; diffusion magnetic resonance imaging; magnetic resonance imaging; middle cerebral artery; neuroimaging; severity of illness index; stroke.

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Figures

**Figure 1**
Distribution of diffusion-weighted imaging (DWI) Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) values across 496 patients.

**Figure 2**
Scatterplot of diffusion-weighted imaging (DWI) lesion volume per Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) value in all middle cerebral artery (MCA) strokes and different subgroups. A, For all analyzed MCA strokes; (B), superficial MCA territory involved; (C), deep MCA territory involved; and (D), superficial and deep MCA territory involved.

**Figure 3**
Receiver-operating characteristics curve to determine an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) value for optimal detection of a diffusion-weighted imaging lesion volume >100 mL; ASPECTS≤6 is identified as optimal threshold (arrow); area under the curve is 0.938 with a 95% confidence interval of 0.891 to 0.985.

See this image and copyright information in PMC

References

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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

Collaborators

Affiliations

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

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