Article Figures & Data
Figures
- Fig 1.
A 75-year-old man, within 2 hours of right-sided stroke and presentation of NIHSS 20. A, NCCT demonstrates subtle loss of the left posterior putamen, internal capsule, and posterior insular cortex (white arrowhead) (ASPECTS 7). B, Cerebral blood flow. C, Cerebral blood volume. D, Mean transit time. Cerebral blood volume demonstrates an abnormality confined to the posterior putamen and internal capsule (ASPECTS 8), with larger cerebral blood flow and mean-transit-time abnormalities corresponding to the left middle cerebral artery M1 segment occlusion (not shown). E, Follow-up NCCT at day 6 shows an indistinct posterior putamen confirmed on diffusion-weighted MR imaging (F). The patient recovered by 18 points with a final NIHSS of 2.
- Fig 2.
A plot of mean baseline ASPECTS NCCT, cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) against major neurologic improvement, demonstrating that only CBV is predictive of 24-hour NIHSS change.
- Fig 3.
A plot of mean baseline ASPECTS NCCT, cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT). Results are dichotomized for clinical outcome by using 2-sample t tests. Favorable outcome was defined as mRS ≤2. Comparison of mean clinical outcomes was based on dichotomized mRS (0–2 versus 3–6), by using unequal variance 2-sample t tests.
Tables
- Table 1:
Mean ASPECTS values and 95% CIs for differences in ASPECTS at baseline for NCCT and CTP compared with final NCCT ASPECTS
NC-CT CBV CBF MTT Final NC-CT ASPECTS MNI (n = 7)a Mean 8.5 9 5.166667 5 9 NCCT −2.3–1.4NS 0.06–3.8S 0.11–3.88S −2.1–1.7NS CBV 0.5–4.3S 0.5–4.4S −1.6–2.2NS CBF −1.8–1.9NS −4.0 to −0.3S MTT −4.0 to −0.3S No MNI (n = 29) Mean 6.8 6.5 4.0 4.0 5.4 NCCT −0.4–1.1NS 1.7–4.0S** S 1.7–4.0S** 0.6–2.2S CBV 1.3–3.6S** S 1.4–3.6S** 0.07–2.3S CBF −1.3–1.4NS −2.6–0.05NS MTT −2.7–0.01NS Note:—MNI indicates major neurologic improvement; CBV, cerebral blood volume; CBF, cerebral blood flow; MTT, mean transit time; NS, nonsignificant; S, significant (level of significance determined by paired t test, P < .05, or S**, P < .01).
a In patients with MNI, mean CBV and NCCT were not significantly different from mean final NCCT ASPECTS, whereas in the absence of MNI, CBF, and MTT most closely approximated final NCCT ASPECTS.
- Table 2:
Performance measures of NCCT, CTP, final ASPECTS, and 24-hour NIHSS change for clinical outcome
Thresholda Good Outcome, mRS ≤2 (% Patients) RR (95% CI) P* Sensitivity (95% CI) Specificity (95% CI) Accuracy NCCT >7 vs ≤7 44 (6) 8.0 (1.1–57.6) .018 0.63 (0.4–0.8) 0.89 (0.47–0.99) 0.69 CBV ≥8 vs <8 45 (0) 15.4 (0.96–246) .002 0.60 (0.4–0.8) 100 (0.66–100) 0.69 Final NCCT >6 vs ≤6 47 (0) 17 (1.1–27.3) .001 1.00 (0.7–1.0) 0.63 (0.44–0.78) 0.72 CBF/MTT >5 vs ≤5 46 (13) 3.54 (1.1–11.8) .046 0.74 (0.5–0.9) 0.67 (0.35–0.88) 0.69 Change NIHSS 24 hours ≥8 86 (10) 8 (2.7–25.2) .0001 0.96 (0.8–1.0) 0.67 (0.3–0.9) 0.89 Note:—RR indicates relative risk; CBV, cerebral blood volume; CBF, cerebral blood flow; MTT, mean transit time.
a Dichotomized thresholds were determined by ROC analysis. Percentage of patients presenting with good outcome above and below the selected threshold is illustrated. The best early predictors of clinical outcome were 24-hour NIHSS and presentation CBV.
* P value was calculated using Fisher exact test.
- Table 3:
Relationship between 3-month functional outcome (mRS) and dichotomized baseline CBV ASPECTS
mRS Total Baseline CBV ASPECTS 0–2 (%) 3 (%) 4 (%) 5 (%) 6 (%) CBV < 8 0 (0) 1 (6.2) 5 (31.2) 7 (43.8) 3 (18.8) 16 CBV ≥ 8 9 (45) 5 (25) 4 (20) 1 (5) 1 (5) 20 Note:—CBV indicates cerebral blood volume.
ICC CI NCCT 0.65 0.49–0.78 CBV 0.69 0.54–0.81 CBF 0.82 0.72–0.89 MTT 0.81 0.7–0.89 Note:—CBV indicates cerebral blood volume; CBF, cerebral blood flow; MTT, mean transit time.
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