通过目测 ASPECTS 界定的大面积缺血核心在 6-24 小时窗口期预测功能预后的准确性可与自动 CT 灌注相媲美。

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-10-07 DOI:10.1177/23969873241286691
Tolga D Dittrich, Anh Nguyen, Peter B Sporns, Anna M Toebak, Lilian F Kriemler, Salome Rudin, Annaelle Zietz, Benjamin Wagner, Filip Barinka, Martin Hänsel, Henrik Gensicke, Raoul Sutter, Christian H Nickel, Mira Katan, Nils Peters, Lars Michels, Zsolt Kulcsár, Grzegorz M Karwacki, Marco Pileggi, Carlo Cereda, Susanne Wegener, Leo H Bonati, Marios Psychogios, Gian Marco De Marchis
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引用次数: 0

摘要

简介:自动 CT 灌注(aCTP)通常用于选择前循环大血管闭塞(aLVO)患者进行血管内治疗(EVT)。目测评估的非对比 CT 阿尔伯塔卒中计划早期 CT 评分(ASPECTS)和基于 CTP 的选择在预测良好功能预后方面的等效性仍不确定:对瑞士卒中登记处(2014-2021 年)的成人 aLVO 患者进行回顾性多中心研究,这些患者在卒中发生 6-24 小时后接受了 EVT 或最佳药物治疗。我们在非对比 CT 上直观评估了 ASPECTS,在 aCTP 上评估了缺血核心体积,定义了 ASPECTS 0-5 和 aCTP CBF 结果:在 210 名患者中,11.4% 的患者 ASPECTS 为 0-5,12.9% 的患者 aCTP 核心容积⩾50 mL。在同一模型中,ASPECTS 而非 aCTP 核心体积与良好的预后相关(ASPECTS:acOR 1.85,95%CI 1.27-2.70,p = 0.001)。ROC 曲线分析表明,在预测 3 个月后的良好功能预后(mRS 0-2)方面,诊断准确性相当(ROC 区域:ASPECTS 0.80 [95%CI 1.27-2.70,P = 0.001):讨论与结论:讨论与结论:在aLVO患者中,目测ASPECTS与自动生成的CTP核心体积在预测3个月后功能预后方面的准确性至少相当。
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Large ischemic core defined by visually assessed ASPECTS predicts functional outcomes comparably accurate to automated CT perfusion in the 6-24 h window.

Introduction: Automated CT perfusion (aCTP) is commonly used to select patients with anterior circulation large vessel occlusion (aLVO) for endovascular treatment (EVT). The equivalence of visually assessed Non-contrast CT Alberta Stroke Program Early CT Scores (ASPECTS) and aCTP based selection in predicting favorable functional outcomes remains uncertain.

Patients and methods: Retrospective multicenter study of adult aLVO patients from the Swiss Stroke Registry (2014-2021) treated with EVT or best medical treatment 6-24 h after stroke onset. We assessed ASPECTS on non-contrast CT visually and ischemic core volumes on aCTP, defining ASPECTS 0-5 and aCTP CBF < 30% volumes ⩾50 mL as large ischemic cores. We used logistic regression to explore the association between CT modalities and favorable functional outcomes (modified Rankin Scale [mRS] score shift toward lower categories) at 3 months. Receiver operating characteristic (ROC) curve analysis compared the predictive accuracy of visually assessed ASPECTS and aCTP ischemic core for favorable outcomes (mRS 0-2) at 3 months.

Results: Of 210 patients, 11.4% had ASPECTS 0-5, and 12.9% aCTP core volumes ⩾50 mL. Within the same model, ASPECTS but not aCTP core volumes were associated with favorable outcomes (ASPECTS: acOR 1.85, 95%CI 1.27-2.70, p = 0.001). The ROC curve analyses showed comparable diagnostic accuracy in predicting favorable functional outcomes (mRS 0-2) at 3 months (ROC areas: ASPECTS 0.80 [95%CI 0.74-0.86] vs aCTP core 0.79 [95%CI 0.72-0.85]).

Discussion and conclusion: In patients with aLVO, visually assessed ASPECTS showed at least comparable accuracy to automatically generated CTP core volumes in predicting functional outcomes at 3 months.

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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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