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PT  - JOURNAL ARTICLE
AU  - Sallustio, F.
AU  - Motta, C.
AU  - Pizzuto, S.
AU  - Diomedi, M.
AU  - Rizzato, B.
AU  - Panella, M.
AU  - Alemseged, F.
AU  - Stefanini, M.
AU  - Fabiano, S.
AU  - Gandini, R.
AU  - Floris, R.
AU  - Stanzione, P.
AU  - Koch, G.
TI  - CT Angiography ASPECTS Predicts Outcome Much Better Than Noncontrast CT in Patients with Stroke Treated Endovascularly
AID  - 10.3174/ajnr.A5264
DP  - 2017 Jun 15
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2017/06/15/ajnr.A5264.short
4100  - http://www.ajnr.org/content/early/2017/06/15/ajnr.A5264.full
AB  - BACKGROUND AND PURPOSE: Noncontrast CT ASPECTS has been investigated as a predictor of outcome in patients with acute ischemic stroke. Our purpose was to investigate whether CTA source images are a better predictor of clinical and radiologic outcomes than NCCT ASPECTS in candidates for endovascular stroke therapy.MATERIALS AND METHODS: CT scans of patients (n = 124) were independently evaluated by 2 readers for baseline NCCT and CTA source image ASPECTS and for follow-up ASPECTS. An mRS of ≤2 at 3 months was considered a favorable outcome. Receiver operating characteristic curve analysis was used to assess the ability of NCCT and CTA source image ASPECTS to identify patients with favorable outcomes. A stepwise multiple regression analysis was performed to find independent predictors of outcome.RESULTS: Baseline CTA source image ASPECTS correlated better than NCCT ASPECTS with follow-up ASPECTS (r = 0.76 versus r = 0.51; P for comparison of the 2 coefficients &amp;lt; .001). Receiver operating characteristic curve analysis showed that baseline CTA source image ASPECTS compared with NCCT ASPECTS can better identify patients with favorable outcome (CTA source image area under the curve = 0.83; 95% CI, 0.76 – 0.91; NCCT area under the curve = 0.67; 95% CI, 0.58 – 0.77; P &amp;lt; .001). Finally, the stepwise regression analysis showed that lower age, good recanalization, lower time to recanalization, and good baseline CTA source image ASPECTS, not NCCT ASPECTS, were independent predictors of favorable outcome.CONCLUSIONS: CTA source image ASPECTS predicts outcome better than NCCT ASPECTS; this finding suggests CTA rather than NCCT as a main step in the decision-making process for patients with acute ischemic stroke.AbbreviationsCTA-SICTA source imagesETendovascular stroke therapy