Correlation of volumetric mismatch and mismatch of Alberta Stroke Program Early CT Scores on CT perfusion maps |
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Authors: | Ke Lin Otto Rapalino Benjamin Lee Kinh G Do Amado R Sussmann Meng Law Bidyut K Pramanik |
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Institution: | (1) Department of Radiology, NYU Medical Center/Bellevue Hospital, 462 First Avenue, NBV 3W39, New York, NY 10016, USA;(2) Department of Radiology, Mount Sinai Medical Center, New York, NY, USA |
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Abstract: | Introduction We aimed to determine if volumetric mismatch between tissue at risk and tissue destined to infarct on computed tomography
perfusion (CTP) can be described by the mismatch of Alberta Stroke Program Early CT Score (ASPECTS).
Materials and methods Forty patients with nonlacunar middle cerebral artery infarct <6 h old who had CTP on admission were retrospectively reviewed.
Two raters segmented the lesion volume on mean transit time (MTT) and cerebral blood volume (CBV) maps using thresholds of
>6 s and <2.0 mL per 100 g, respectively. Two other raters assigned ASPECTS to the same MTT and CBV maps while blinded to
the volumetric data. Volumetric mismatch was deemed present if ≥20%. ASPECTS mismatch (=CBV ASPECTS − MTT ASPECTS) was deemed
present if ≥1. Correlation between the two types of mismatches was assessed by Spearman’s coefficient (ρ). ROC curve analyses were performed to determine the optimal ASPECTS mismatch cut point for volumetric mismatch ≥20%, ≥50%,
≥100%, and ≥150%.
Results Median volumetric mismatch was 130% (range 10.9–2,031%) with 31 (77.5%) being ≥20%. Median ASPECTS mismatch was 2 (range 0–6)
with 26 (65%) being ≥1. ASPECTS mismatch correlated strongly with volumetric mismatch with ρ = 0.763 95% CI 0.585–0.870], p < 0.0001. Sensitivity and specificity for volumetric mismatch ≥20% was 83.9% 95% CI 65.5–93.5] and 100% 95% CI 65.9–100],
respectively, using ASPECTS mismatch ≥1. Volumetric mismatch ≥50%, ≥100%, and ≥150% were optimally identified using ASPECTS
mismatch ≥1, ≥2, and ≥2, respectively.
Conclusion On CTP, ASPECTS mismatch showed strong correlation to volumetric mismatch. ASPECTS mismatch ≥1 was the optimal cut point for
volumetric mismatch ≥20%. |
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Keywords: | Perfusion computed tomography Perfusion diffusion mismatch Alberta Stroke Program Early CT Score Ischemic stroke Recanalization therapy |
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