Pamela Whitney Schaefer MD, Presenter: Nothing to Disclose

Amrish Mehta, Abstract Co-Author: Nothing to Disclose

Erica Camargo, Abstract Co-Author: Nothing to Disclose

Lee H. Schwamm MD, Abstract Co-Author: Nothing to Disclose

Ramon G Gonzalez, Abstract Co-Author: Nothing to Disclose

Michael Howard Lev MD, Abstract Co-Author: Nothing to Disclose

Walter Koroshetz, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

The Alberta Stroke Program Early CT Score (ASPECTS) is a grading system that assesses early ischemic CT changes of acute middle cerebral artery (MCA) stroke and correlates highly with acute and follow-up neurological assessment tests. Our purpose was to determine if a modified(m) ASPECT score – obtained from DWI/PWI - could predict admission clinical status, measured by NIHSS score.

49 patients with acute MCA stroke and DWI/PWI imaging within 12 hours, were evaluated. Two neuroradiologists obtained mASPECT scores on DWI, blood volume(CBV), blood flow(CBF), and transit time(MTT) maps in ten regions: 1)lentiform nucleus, 2)internal capsule, 3)caudate nucleus, 4)insula, 5)inferior frontal, 6)anterior temporal, 7)posterior temporal, 8)middle frontal, 9)precentral, 10)post central/inferior parietal. Each region was rated as: 1=uninvolved, 2 = possibly involved, 3 = 50% involved. For each patient, scores for each region were added to obtain a mASPECT score for each DWI/PWI map. An experienced neurologist obtained NIHSS scores from medical records. Spearman correlation coefficients for NIHSS vs DWI, CBV, CBF and MTT mASPECT scores were obtained.

18 pts were imaged within 6 hours(early), 31 patients at 6-12 hours. NIHSS scores ranged from 0-29(mean 8.5). mASPECT scores ranged from 12-32(mean 18.3) for DWI; 12-33(mean 18.5) for CBV; 12-39(mean 21.2) for CBF; and 12-38(mean 21.6) for MTT. Interobserver agreement was good (a maximal 3-point deviation for all mASPECTS scores). The NIHSS and mASPECT scores correlated highly: for CBV maps, r =0.75 all, r = 0.87 early; for DWI maps r = 0.72 all, r = 0.87 early; for CBF maps r = 0.71 all, r = 0.86 early; for MTT maps r = 0.70 all, r = 0.85 early.

The mASPECT score is a reliable grading system for assessing acute ischemia on DWI/PWI in acute MCA strokes. Admission mASPECT correlates highly with admission NIHSS score, and provides an excellent assessment of acute clinical status, which may be valuable in the management of acute stroke patients. Future investigation may reveal if the mASPECT score is useful for predicting clinical outcome.

Schaefer, P, Mehta, A, Camargo, E, Schwamm, L, Gonzalez, R, Lev, M, Koroshetz, W, et al, , Modified ASPECT Score (mASPECT) on Diffusion/Perfusion MRI Correlates Strongly with NIH Stroke Scale Score (NIHSS) in Acute Stroke.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4412767.html