Validity of Acute Stroke Lesion Volume Estimation by Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomographic Score Depends on Lesion Location in 496 Patients With Middle Cerebral Artery Stroke
Identifieur interne : 001268 ( Pmc/Checkpoint ); précédent : 001267; suivant : 001269Validity of Acute Stroke Lesion Volume Estimation by Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomographic Score Depends on Lesion Location in 496 Patients With Middle Cerebral Artery Stroke
Auteurs : Julian Schröder ; Bastian Cheng ; Martin Ebinger ; Martin Köhrmann ; Ona Wu ; Dong-Wha Kang ; David S. Liebeskind ; Thomas Tourdias ; Oliver C. Singer ; Soren Christensen ; Bruce Campbell ; Marie Luby ; Steven Warach ; Jens Fiehler ; Jochen B. Fiebach ; Christian Gerloff ; Götz ThomallaSource :
- Stroke; a journal of cerebral circulation [ 0039-2499 ] ; 2014.
Abstract
Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) has been used to estimate diffusion-weighted imaging (DWI) lesion volume in acute stroke. We aimed to assess correlations of DWI-ASPECTS with lesion volume in different middle cerebral artery (MCA) subregions and reproduce existing ASPECTS thresholds of a malignant profile defined by lesion volume ≥100 mL.
We analyzed data of patients with MCA stroke from a prospective observational study of DWI and fluid-attenuated inversion recovery in acute stroke. DWI-ASPECTS and lesion volume were calculated. The population was divided into subgroups based on lesion localization (superficial MCA territory, deep MCA territory, or both). Correlation of ASPECTS and infarct volume was calculated, and receiver-operating characteristics curve analysis was performed to identify the optimal ASPECTS threshold for ≥100-mL lesion volume.
A total of 496 patients were included. There was a significant negative correlation between ASPECTS and DWI lesion volume (
ASPECTS has limitations when lesion location is not considered. Identification of patients with malignant profile by DWI-ASPECTS may be unreliable. ASPECTS may be a useful tool for the evaluation of noncontrast computed tomography. However, if MRI is used, ASPECTS seems dispensable because lesion volume can easily be quantified on DWI maps.
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DOI: 10.1161/STROKEAHA.114.006694
PubMed: 25316278
PubMed Central: 4749150
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Validity of Acute Stroke Lesion Volume Estimation by Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomographic Score Depends on Lesion Location in 496 Patients With Middle Cerebral Artery Stroke</title><author><name sortKey="Schroder, Julian" sort="Schroder, Julian" uniqKey="Schroder J" first="Julian" last="Schröder">Julian Schröder</name></author><author><name sortKey="Cheng, Bastian" sort="Cheng, Bastian" uniqKey="Cheng B" first="Bastian" last="Cheng">Bastian Cheng</name></author><author><name sortKey="Ebinger, Martin" sort="Ebinger, Martin" uniqKey="Ebinger M" first="Martin" last="Ebinger">Martin Ebinger</name></author><author><name sortKey="Kohrmann, Martin" sort="Kohrmann, Martin" uniqKey="Kohrmann M" first="Martin" last="Köhrmann">Martin Köhrmann</name></author><author><name sortKey="Wu, Ona" sort="Wu, Ona" uniqKey="Wu O" first="Ona" last="Wu">Ona Wu</name></author><author><name sortKey="Kang, Dong Wha" sort="Kang, Dong Wha" uniqKey="Kang D" first="Dong-Wha" last="Kang">Dong-Wha Kang</name></author><author><name sortKey="Liebeskind, David S" sort="Liebeskind, David S" uniqKey="Liebeskind D" first="David S." last="Liebeskind">David S. Liebeskind</name></author><author><name sortKey="Tourdias, Thomas" sort="Tourdias, Thomas" uniqKey="Tourdias T" first="Thomas" last="Tourdias">Thomas Tourdias</name></author><author><name sortKey="Singer, Oliver C" sort="Singer, Oliver C" uniqKey="Singer O" first="Oliver C." last="Singer">Oliver C. Singer</name></author><author><name sortKey="Christensen, Soren" sort="Christensen, Soren" uniqKey="Christensen S" first="Soren" last="Christensen">Soren Christensen</name></author><author><name sortKey="Campbell, Bruce" sort="Campbell, Bruce" uniqKey="Campbell B" first="Bruce" last="Campbell">Bruce Campbell</name></author><author><name sortKey="Luby, Marie" sort="Luby, Marie" uniqKey="Luby M" first="Marie" last="Luby">Marie Luby</name></author><author><name sortKey="Warach, Steven" sort="Warach, Steven" uniqKey="Warach S" first="Steven" last="Warach">Steven Warach</name></author><author><name sortKey="Fiehler, Jens" sort="Fiehler, Jens" uniqKey="Fiehler J" first="Jens" last="Fiehler">Jens Fiehler</name></author><author><name sortKey="Fiebach, Jochen B" sort="Fiebach, Jochen B" uniqKey="Fiebach J" first="Jochen B." last="Fiebach">Jochen B. Fiebach</name></author><author><name sortKey="Gerloff, Christian" sort="Gerloff, Christian" uniqKey="Gerloff C" first="Christian" last="Gerloff">Christian Gerloff</name></author><author><name sortKey="Thomalla, Gotz" sort="Thomalla, Gotz" uniqKey="Thomalla G" first="Götz" last="Thomalla">Götz Thomalla</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25316278</idno><idno type="pmc">4749150</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4749150</idno><idno type="RBID">PMC:4749150</idno><idno type="doi">10.1161/STROKEAHA.114.006694</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">001C74</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001C74</idno><idno type="wicri:Area/Pmc/Curation">001B32</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">001B32</idno><idno type="wicri:Area/Pmc/Checkpoint">001268</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001268</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Validity of Acute Stroke Lesion Volume Estimation by Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomographic Score Depends on Lesion Location in 496 Patients With Middle Cerebral Artery Stroke</title><author><name sortKey="Schroder, Julian" sort="Schroder, Julian" uniqKey="Schroder J" first="Julian" last="Schröder">Julian Schröder</name></author><author><name sortKey="Cheng, Bastian" sort="Cheng, Bastian" uniqKey="Cheng B" first="Bastian" last="Cheng">Bastian Cheng</name></author><author><name sortKey="Ebinger, Martin" sort="Ebinger, Martin" uniqKey="Ebinger M" first="Martin" last="Ebinger">Martin Ebinger</name></author><author><name sortKey="Kohrmann, Martin" sort="Kohrmann, Martin" uniqKey="Kohrmann M" first="Martin" last="Köhrmann">Martin Köhrmann</name></author><author><name sortKey="Wu, Ona" sort="Wu, Ona" uniqKey="Wu O" first="Ona" last="Wu">Ona Wu</name></author><author><name sortKey="Kang, Dong Wha" sort="Kang, Dong Wha" uniqKey="Kang D" first="Dong-Wha" last="Kang">Dong-Wha Kang</name></author><author><name sortKey="Liebeskind, David S" sort="Liebeskind, David S" uniqKey="Liebeskind D" first="David S." last="Liebeskind">David S. Liebeskind</name></author><author><name sortKey="Tourdias, Thomas" sort="Tourdias, Thomas" uniqKey="Tourdias T" first="Thomas" last="Tourdias">Thomas Tourdias</name></author><author><name sortKey="Singer, Oliver C" sort="Singer, Oliver C" uniqKey="Singer O" first="Oliver C." last="Singer">Oliver C. Singer</name></author><author><name sortKey="Christensen, Soren" sort="Christensen, Soren" uniqKey="Christensen S" first="Soren" last="Christensen">Soren Christensen</name></author><author><name sortKey="Campbell, Bruce" sort="Campbell, Bruce" uniqKey="Campbell B" first="Bruce" last="Campbell">Bruce Campbell</name></author><author><name sortKey="Luby, Marie" sort="Luby, Marie" uniqKey="Luby M" first="Marie" last="Luby">Marie Luby</name></author><author><name sortKey="Warach, Steven" sort="Warach, Steven" uniqKey="Warach S" first="Steven" last="Warach">Steven Warach</name></author><author><name sortKey="Fiehler, Jens" sort="Fiehler, Jens" uniqKey="Fiehler J" first="Jens" last="Fiehler">Jens Fiehler</name></author><author><name sortKey="Fiebach, Jochen B" sort="Fiebach, Jochen B" uniqKey="Fiebach J" first="Jochen B." last="Fiebach">Jochen B. Fiebach</name></author><author><name sortKey="Gerloff, Christian" sort="Gerloff, Christian" uniqKey="Gerloff C" first="Christian" last="Gerloff">Christian Gerloff</name></author><author><name sortKey="Thomalla, Gotz" sort="Thomalla, Gotz" uniqKey="Thomalla G" first="Götz" last="Thomalla">Götz Thomalla</name></author></analytic><series><title level="j">Stroke; a journal of cerebral circulation</title><idno type="ISSN">0039-2499</idno><idno type="eISSN">1524-4628</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background and Purpose</title><p id="P1">Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) has been used to estimate diffusion-weighted imaging (DWI) lesion volume in acute stroke. We aimed to assess correlations of DWI-ASPECTS with lesion volume in different middle cerebral artery (MCA) subregions and reproduce existing ASPECTS thresholds of a malignant profile defined by lesion volume ≥100 mL.</p></sec><sec id="S2"><title>Methods</title><p id="P2">We analyzed data of patients with MCA stroke from a prospective observational study of DWI and fluid-attenuated inversion recovery in acute stroke. DWI-ASPECTS and lesion volume were calculated. The population was divided into subgroups based on lesion localization (superficial MCA territory, deep MCA territory, or both). Correlation of ASPECTS and infarct volume was calculated, and receiver-operating characteristics curve analysis was performed to identify the optimal ASPECTS threshold for ≥100-mL lesion volume.</p></sec><sec id="S3"><title>Results</title><p id="P3">A total of 496 patients were included. There was a significant negative correlation between ASPECTS and DWI lesion volume (<italic>r</italic>=−0.78; <italic>P</italic><0.0001). With regards to lesion localization, correlation was weaker in deep MCA region (<italic>r</italic>=−0.19; <italic>P</italic>=0.038) when compared with superficial (<italic>r</italic>=−0.72; <italic>P</italic><0.001) or combined superficial and deep MCA lesions (<italic>r</italic>=−0.72; <italic>P</italic><0.001). Receiver-operating characteristics analysis revealed ASPECTS≤6 as best cutoff to identify ≥100-mL DWI lesion volume; however, positive predictive value was low (0.35).</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">ASPECTS has limitations when lesion location is not considered. Identification of patients with malignant profile by DWI-ASPECTS may be unreliable. ASPECTS may be a useful tool for the evaluation of noncontrast computed tomography. However, if MRI is used, ASPECTS seems dispensable because lesion volume can easily be quantified on DWI maps.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">0235266</journal-id><journal-id journal-id-type="pubmed-jr-id">7613</journal-id><journal-id journal-id-type="nlm-ta">Stroke</journal-id><journal-id journal-id-type="iso-abbrev">Stroke</journal-id><journal-title-group><journal-title>Stroke; a journal of cerebral circulation</journal-title></journal-title-group><issn pub-type="ppub">0039-2499</issn><issn pub-type="epub">1524-4628</issn></journal-meta><article-meta><article-id pub-id-type="pmid">25316278</article-id><article-id pub-id-type="pmc">4749150</article-id><article-id pub-id-type="doi">10.1161/STROKEAHA.114.006694</article-id><article-id pub-id-type="manuscript">NIHMS757211</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Validity of Acute Stroke Lesion Volume Estimation by Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomographic Score Depends on Lesion Location in 496 Patients With Middle Cerebral Artery Stroke</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Schröder</surname><given-names>Julian</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Cheng</surname><given-names>Bastian</given-names></name><degrees>MD, MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Ebinger</surname><given-names>Martin</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Köhrmann</surname><given-names>Martin</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Wu</surname><given-names>Ona</given-names></name><degrees>PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Kang</surname><given-names>Dong-Wha</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Liebeskind</surname><given-names>David S.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Tourdias</surname><given-names>Thomas</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Singer</surname><given-names>Oliver C.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Christensen</surname><given-names>Soren</given-names></name><degrees>PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Campbell</surname><given-names>Bruce</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Luby</surname><given-names>Marie</given-names></name><degrees>PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Warach</surname><given-names>Steven</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Fiehler</surname><given-names>Jens</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Fiebach</surname><given-names>Jochen B.</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Gerloff</surname><given-names>Christian</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Thomalla</surname><given-names>Götz</given-names></name><degrees>MD</degrees></contrib><on-behalf-of>on behalf of the STIR and VISTA Imaging Investigators</on-behalf-of><xref rid="FN2" ref-type="author-notes">*</xref><aff id="A1">Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.S., B. Cheng, C.G., G.T.); Centrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany (M.E., J.B.F.); Klinik für Neurologie, Universität Erlangen-Nürnberg, Erlangen, Germany (M.K.); Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (O.W.); Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-W.K.); Department of Neurology, University of California, Los Angeles (D.S.L.); Université de Bordeaux, CHU de Bordeaux, Service de NeuroImagerie Diagnostique de Thérapeutique, Bordeaux, France (T.T.); Klinik für Neurologie, Universitätsklinikum Frankfurt, Frankfurt, Germany (O.C.S.); Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (S.C., B. Campbell); National Institute of Neurological Disorders and Stroke, Bethesda, MD (M.L.); Department of Neurology and Neurotherapeutics, Seton/UT Southwestern Clinical Research Institute of Austin, UT Southwestern Medical Center, Austin, TX (S.W.); and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany (J.F.)</aff></contrib-group><author-notes><corresp id="FN1">Correspondence to Julian Schröder, MD, Martinistraße 52, 20246 Hamburg, Germany. <email>jul.schroeder@uke.de</email></corresp><fn id="FN2"><label>*</label><p>A list of all STIR and VISTA Imaging study participants is given in the <xref rid="APP1" ref-type="app">Appendix</xref>.</p></fn></author-notes><pub-date pub-type="nihms-submitted"><day>5</day><month>2</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>14</day><month>10</month><year>2014</year></pub-date><pub-date pub-type="ppub"><month>12</month><year>2014</year></pub-date><pub-date pub-type="pmc-release"><day>10</day><month>2</month><year>2016</year></pub-date><volume>45</volume><issue>12</issue><fpage>3583</fpage><lpage>3588</lpage><pmc-comment>elocation-id from pubmed: 10.1161/STROKEAHA.114.006694</pmc-comment>
<abstract><sec id="S1"><title>Background and Purpose</title><p id="P1">Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) has been used to estimate diffusion-weighted imaging (DWI) lesion volume in acute stroke. We aimed to assess correlations of DWI-ASPECTS with lesion volume in different middle cerebral artery (MCA) subregions and reproduce existing ASPECTS thresholds of a malignant profile defined by lesion volume ≥100 mL.</p></sec><sec id="S2"><title>Methods</title><p id="P2">We analyzed data of patients with MCA stroke from a prospective observational study of DWI and fluid-attenuated inversion recovery in acute stroke. DWI-ASPECTS and lesion volume were calculated. The population was divided into subgroups based on lesion localization (superficial MCA territory, deep MCA territory, or both). Correlation of ASPECTS and infarct volume was calculated, and receiver-operating characteristics curve analysis was performed to identify the optimal ASPECTS threshold for ≥100-mL lesion volume.</p></sec><sec id="S3"><title>Results</title><p id="P3">A total of 496 patients were included. There was a significant negative correlation between ASPECTS and DWI lesion volume (<italic>r</italic>=−0.78; <italic>P</italic><0.0001). With regards to lesion localization, correlation was weaker in deep MCA region (<italic>r</italic>=−0.19; <italic>P</italic>=0.038) when compared with superficial (<italic>r</italic>=−0.72; <italic>P</italic><0.001) or combined superficial and deep MCA lesions (<italic>r</italic>=−0.72; <italic>P</italic><0.001). Receiver-operating characteristics analysis revealed ASPECTS≤6 as best cutoff to identify ≥100-mL DWI lesion volume; however, positive predictive value was low (0.35).</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">ASPECTS has limitations when lesion location is not considered. Identification of patients with malignant profile by DWI-ASPECTS may be unreliable. ASPECTS may be a useful tool for the evaluation of noncontrast computed tomography. However, if MRI is used, ASPECTS seems dispensable because lesion volume can easily be quantified on DWI maps.</p></sec></abstract><kwd-group><kwd>brain ischemia</kwd><kwd>diffusion magnetic resonance imaging</kwd><kwd>magnetic resonance imaging</kwd><kwd>middle cerebral artery</kwd><kwd>neuroimaging</kwd><kwd>severity of illness index</kwd><kwd>stroke</kwd></kwd-group></article-meta></front></pmc><affiliations><list></list><tree><noCountry><name sortKey="Campbell, Bruce" sort="Campbell, Bruce" uniqKey="Campbell B" first="Bruce" last="Campbell">Bruce Campbell</name><name sortKey="Cheng, Bastian" sort="Cheng, Bastian" uniqKey="Cheng B" first="Bastian" last="Cheng">Bastian Cheng</name><name sortKey="Christensen, Soren" sort="Christensen, Soren" uniqKey="Christensen S" first="Soren" last="Christensen">Soren Christensen</name><name sortKey="Ebinger, Martin" sort="Ebinger, Martin" uniqKey="Ebinger M" first="Martin" last="Ebinger">Martin Ebinger</name><name sortKey="Fiebach, Jochen B" sort="Fiebach, Jochen B" uniqKey="Fiebach J" first="Jochen B." last="Fiebach">Jochen B. Fiebach</name><name sortKey="Fiehler, Jens" sort="Fiehler, Jens" uniqKey="Fiehler J" first="Jens" last="Fiehler">Jens Fiehler</name><name sortKey="Gerloff, Christian" sort="Gerloff, Christian" uniqKey="Gerloff C" first="Christian" last="Gerloff">Christian Gerloff</name><name sortKey="Kang, Dong Wha" sort="Kang, Dong Wha" uniqKey="Kang D" first="Dong-Wha" last="Kang">Dong-Wha Kang</name><name sortKey="Kohrmann, Martin" sort="Kohrmann, Martin" uniqKey="Kohrmann M" first="Martin" last="Köhrmann">Martin Köhrmann</name><name sortKey="Liebeskind, David S" sort="Liebeskind, David S" uniqKey="Liebeskind D" first="David S." last="Liebeskind">David S. Liebeskind</name><name sortKey="Luby, Marie" sort="Luby, Marie" uniqKey="Luby M" first="Marie" last="Luby">Marie Luby</name><name sortKey="Schroder, Julian" sort="Schroder, Julian" uniqKey="Schroder J" first="Julian" last="Schröder">Julian Schröder</name><name sortKey="Singer, Oliver C" sort="Singer, Oliver C" uniqKey="Singer O" first="Oliver C." last="Singer">Oliver C. Singer</name><name sortKey="Thomalla, Gotz" sort="Thomalla, Gotz" uniqKey="Thomalla G" first="Götz" last="Thomalla">Götz Thomalla</name><name sortKey="Tourdias, Thomas" sort="Tourdias, Thomas" uniqKey="Tourdias T" first="Thomas" last="Tourdias">Thomas Tourdias</name><name sortKey="Warach, Steven" sort="Warach, Steven" uniqKey="Warach S" first="Steven" last="Warach">Steven Warach</name><name sortKey="Wu, Ona" sort="Wu, Ona" uniqKey="Wu O" first="Ona" last="Wu">Ona Wu</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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