ASPECTS discrepancies between CT and MR imaging: Analysis and implications for triage protocols in acute ischemic stroke

Ferdinand Hui, Nancy A. Obuchowski, Seby John, Gabor Toth, Irene Katzan, Dolora Wisco, Esteban Cheng-Ching, Ken Uchino, Shu Mei Man, Shazam Hussain

Research output: Contribution to journalArticle

Abstract

Background Optimal imaging triage for intervention for large vessel occlusions remains unclear. MR-based imaging provides ischemic core volumes at the cost of increased imaging time. CT Alberta Stroke Program Early CT Score (ASPECTS) estimates are faster, but may be less sensitive. Objective To assesses the rate at which MRI changed management in comparison with CT imaging alone. Methods Retrospective analysis of patients with acute ischemic stroke undergoing imaging triage for endovascular therapy was performed between 2008 and 2013. Univariate and multivariate analyses were performed. Multivariate logistic regression was used to evaluate the effect of time on disagreement in MRI and CT ASPECTS scores. Results A total of 241 patients underwent both diffusion-weighted imaging (DWI) and CT. Six patients with DWI ASPECTS ≥6 and CT ASPECTS <6 were omitted, leaving 235 patients. For 47 patients, disagreement between the two modalities resulted in different treatment recommendations. The estimated probability of disagreement was 20.0% (95% CI 15.4% to 25.6%). In a multivariate logistic regression, CT ASPECTS >7 (p=0.004) and admission National Institutes of Health Stroke Scale (NIHSS) score <16 (p=0.008) were simultaneously significant predictors of agreement in ASPECTS. The time between modalities was a marginally significant predictor (p=0.080). Conclusions The study suggests that patients with NIHSS scores at admission of <16 and patients with CT ASPECTS >7 have a higher likelihood of agreement between CT and DWI based on an ASPECTS cut-off value of 6. Additional MRI for triage in patients with NIHSS at admission of >16, and ASPECTS of 6 or 7 may be more likely to change management. Unsurprisingly, patients with low CT ASPECTS had good correlation with MRI ASPECTS.

Original languageEnglish (US)
Pages (from-to)240-243
Number of pages4
JournalJournal of NeuroInterventional Surgery
Volume9
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

Fingerprint

Alberta
Triage
Stroke
National Institutes of Health (U.S.)
Multivariate Analysis
Logistic Models

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

ASPECTS discrepancies between CT and MR imaging : Analysis and implications for triage protocols in acute ischemic stroke. / Hui, Ferdinand; Obuchowski, Nancy A.; John, Seby; Toth, Gabor; Katzan, Irene; Wisco, Dolora; Cheng-Ching, Esteban; Uchino, Ken; Man, Shu Mei; Hussain, Shazam.

In: Journal of NeuroInterventional Surgery, Vol. 9, No. 3, 01.03.2017, p. 240-243.

Research output: Contribution to journalArticle

Hui, F, Obuchowski, NA, John, S, Toth, G, Katzan, I, Wisco, D, Cheng-Ching, E, Uchino, K, Man, SM & Hussain, S 2017, 'ASPECTS discrepancies between CT and MR imaging: Analysis and implications for triage protocols in acute ischemic stroke', Journal of NeuroInterventional Surgery, vol. 9, no. 3, pp. 240-243. https://doi.org/10.1136/neurintsurg-2015-012188
Hui, Ferdinand ; Obuchowski, Nancy A. ; John, Seby ; Toth, Gabor ; Katzan, Irene ; Wisco, Dolora ; Cheng-Ching, Esteban ; Uchino, Ken ; Man, Shu Mei ; Hussain, Shazam. / ASPECTS discrepancies between CT and MR imaging : Analysis and implications for triage protocols in acute ischemic stroke. In: Journal of NeuroInterventional Surgery. 2017 ; Vol. 9, No. 3. pp. 240-243.
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abstract = "Background Optimal imaging triage for intervention for large vessel occlusions remains unclear. MR-based imaging provides ischemic core volumes at the cost of increased imaging time. CT Alberta Stroke Program Early CT Score (ASPECTS) estimates are faster, but may be less sensitive. Objective To assesses the rate at which MRI changed management in comparison with CT imaging alone. Methods Retrospective analysis of patients with acute ischemic stroke undergoing imaging triage for endovascular therapy was performed between 2008 and 2013. Univariate and multivariate analyses were performed. Multivariate logistic regression was used to evaluate the effect of time on disagreement in MRI and CT ASPECTS scores. Results A total of 241 patients underwent both diffusion-weighted imaging (DWI) and CT. Six patients with DWI ASPECTS ≥6 and CT ASPECTS <6 were omitted, leaving 235 patients. For 47 patients, disagreement between the two modalities resulted in different treatment recommendations. The estimated probability of disagreement was 20.0{\%} (95{\%} CI 15.4{\%} to 25.6{\%}). In a multivariate logistic regression, CT ASPECTS >7 (p=0.004) and admission National Institutes of Health Stroke Scale (NIHSS) score <16 (p=0.008) were simultaneously significant predictors of agreement in ASPECTS. The time between modalities was a marginally significant predictor (p=0.080). Conclusions The study suggests that patients with NIHSS scores at admission of <16 and patients with CT ASPECTS >7 have a higher likelihood of agreement between CT and DWI based on an ASPECTS cut-off value of 6. Additional MRI for triage in patients with NIHSS at admission of >16, and ASPECTS of 6 or 7 may be more likely to change management. Unsurprisingly, patients with low CT ASPECTS had good correlation with MRI ASPECTS.",
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T2 - Analysis and implications for triage protocols in acute ischemic stroke

AU - Hui, Ferdinand

AU - Obuchowski, Nancy A.

AU - John, Seby

AU - Toth, Gabor

AU - Katzan, Irene

AU - Wisco, Dolora

AU - Cheng-Ching, Esteban

AU - Uchino, Ken

AU - Man, Shu Mei

AU - Hussain, Shazam

PY - 2017/3/1

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N2 - Background Optimal imaging triage for intervention for large vessel occlusions remains unclear. MR-based imaging provides ischemic core volumes at the cost of increased imaging time. CT Alberta Stroke Program Early CT Score (ASPECTS) estimates are faster, but may be less sensitive. Objective To assesses the rate at which MRI changed management in comparison with CT imaging alone. Methods Retrospective analysis of patients with acute ischemic stroke undergoing imaging triage for endovascular therapy was performed between 2008 and 2013. Univariate and multivariate analyses were performed. Multivariate logistic regression was used to evaluate the effect of time on disagreement in MRI and CT ASPECTS scores. Results A total of 241 patients underwent both diffusion-weighted imaging (DWI) and CT. Six patients with DWI ASPECTS ≥6 and CT ASPECTS <6 were omitted, leaving 235 patients. For 47 patients, disagreement between the two modalities resulted in different treatment recommendations. The estimated probability of disagreement was 20.0% (95% CI 15.4% to 25.6%). In a multivariate logistic regression, CT ASPECTS >7 (p=0.004) and admission National Institutes of Health Stroke Scale (NIHSS) score <16 (p=0.008) were simultaneously significant predictors of agreement in ASPECTS. The time between modalities was a marginally significant predictor (p=0.080). Conclusions The study suggests that patients with NIHSS scores at admission of <16 and patients with CT ASPECTS >7 have a higher likelihood of agreement between CT and DWI based on an ASPECTS cut-off value of 6. Additional MRI for triage in patients with NIHSS at admission of >16, and ASPECTS of 6 or 7 may be more likely to change management. Unsurprisingly, patients with low CT ASPECTS had good correlation with MRI ASPECTS.

AB - Background Optimal imaging triage for intervention for large vessel occlusions remains unclear. MR-based imaging provides ischemic core volumes at the cost of increased imaging time. CT Alberta Stroke Program Early CT Score (ASPECTS) estimates are faster, but may be less sensitive. Objective To assesses the rate at which MRI changed management in comparison with CT imaging alone. Methods Retrospective analysis of patients with acute ischemic stroke undergoing imaging triage for endovascular therapy was performed between 2008 and 2013. Univariate and multivariate analyses were performed. Multivariate logistic regression was used to evaluate the effect of time on disagreement in MRI and CT ASPECTS scores. Results A total of 241 patients underwent both diffusion-weighted imaging (DWI) and CT. Six patients with DWI ASPECTS ≥6 and CT ASPECTS <6 were omitted, leaving 235 patients. For 47 patients, disagreement between the two modalities resulted in different treatment recommendations. The estimated probability of disagreement was 20.0% (95% CI 15.4% to 25.6%). In a multivariate logistic regression, CT ASPECTS >7 (p=0.004) and admission National Institutes of Health Stroke Scale (NIHSS) score <16 (p=0.008) were simultaneously significant predictors of agreement in ASPECTS. The time between modalities was a marginally significant predictor (p=0.080). Conclusions The study suggests that patients with NIHSS scores at admission of <16 and patients with CT ASPECTS >7 have a higher likelihood of agreement between CT and DWI based on an ASPECTS cut-off value of 6. Additional MRI for triage in patients with NIHSS at admission of >16, and ASPECTS of 6 or 7 may be more likely to change management. Unsurprisingly, patients with low CT ASPECTS had good correlation with MRI ASPECTS.

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