Estimation of ischemic core in acute ischemic stroke with CT angiography and non-contrast CT: Attenuation changes in ASPECTS regions vs. automated ASPECTS scoring
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...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Neuroscience |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnins.2022.933753/full |
| _version_ | 1818161251039051776 |
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| author | Jing Li Jing Li Yuling Peng Jiayang Liu Jiajing Wu Yunzhuo Yao Sirun Gu Zhiwei Zhang Yi Li Jingjie Wang Yongmei Li |
| author_facet | Jing Li Jing Li Yuling Peng Jiayang Liu Jiajing Wu Yunzhuo Yao Sirun Gu Zhiwei Zhang Yi Li Jingjie Wang Yongmei Li |
| author_sort | Jing Li |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T16:14:48Z |
| format | Article |
| id | doaj.art-a85301c0967b4411867154a705366b97 |
| institution | Directory Open Access Journal |
| issn | 1662-453X |
| language | English |
| last_indexed | 2024-12-11T16:14:48Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neuroscience |
| spelling | doaj.art-a85301c0967b4411867154a705366b972022-12-22T00:58:59ZengFrontiers Media S.A.Frontiers in Neuroscience1662-453X2022-07-011610.3389/fnins.2022.933753933753Estimation of ischemic core in acute ischemic stroke with CT angiography and non-contrast CT: Attenuation changes in ASPECTS regions vs. automated ASPECTS scoringJing Li0Jing Li1Yuling Peng2Jiayang Liu3Jiajing Wu4Yunzhuo Yao5Sirun Gu6Zhiwei Zhang7Yi Li8Jingjie Wang9Yongmei Li10Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaMedical Imaging Center, Central Hospital of Shaoyang, Shaoyang, ChinaDepartment of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaArtificial Intelligence and Clinical Innovation Research, Neusoft Research of Intelligent Healthcare Technology, Co., Ltd., Shanghai, ChinaDepartment of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaPurposeReperfusion 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.https://www.frontiersin.org/articles/10.3389/fnins.2022.933753/fullischemic strokereperfusion therapyAlberta Stroke Program Early CT Scorenon-contrast CTCTA source imagesperfusion imaging |
| spellingShingle | Jing Li Jing Li Yuling Peng Jiayang Liu Jiajing Wu Yunzhuo Yao Sirun Gu Zhiwei Zhang Yi Li Jingjie Wang Yongmei Li Estimation of ischemic core in acute ischemic stroke with CT angiography and non-contrast CT: Attenuation changes in ASPECTS regions vs. automated ASPECTS scoring Frontiers in Neuroscience ischemic stroke reperfusion therapy Alberta Stroke Program Early CT Score non-contrast CT CTA source images perfusion imaging |
| title | Estimation of ischemic core in acute ischemic stroke with CT angiography and non-contrast CT: Attenuation changes in ASPECTS regions vs. automated ASPECTS scoring |
| title_full | Estimation of ischemic core in acute ischemic stroke with CT angiography and non-contrast CT: Attenuation changes in ASPECTS regions vs. automated ASPECTS scoring |
| title_fullStr | Estimation of ischemic core in acute ischemic stroke with CT angiography and non-contrast CT: Attenuation changes in ASPECTS regions vs. automated ASPECTS scoring |
| title_full_unstemmed | Estimation of ischemic core in acute ischemic stroke with CT angiography and non-contrast CT: Attenuation changes in ASPECTS regions vs. automated ASPECTS scoring |
| title_short | Estimation of ischemic core in acute ischemic stroke with CT angiography and non-contrast CT: Attenuation changes in ASPECTS regions vs. automated ASPECTS scoring |
| title_sort | estimation of ischemic core in acute ischemic stroke with ct angiography and non contrast ct attenuation changes in aspects regions vs automated aspects scoring |
| topic | ischemic stroke reperfusion therapy Alberta Stroke Program Early CT Score non-contrast CT CTA source images perfusion imaging |
| url | https://www.frontiersin.org/articles/10.3389/fnins.2022.933753/full |
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