Research progress of clinical application of ASPECT score in acute ischemic stroke

doi:10.3969/j.issn.1674-8115.2022.07.011

Abstract

Abstract:

Acute ischemic stroke (AIS) is characterized by a high rate of disability and mortality, and rapid and accurate diagnosis and appropriate treatment are the keys. The severity of AIS patients depends on the location of early ischemic changes (EIC) in the brain tissue and the size of the lesion, so it is necessary to evaluate the patients' conditions by combining with imaging. The Alberta stroke program early CT score (ASPECT score) is a 10-point imaging score system that evaluates the EIC in the middle cerebral artery supplying region of the stroke patients in an accurate and simple way by quantifying the severity in terms of the imaging to help clinicians make medical decisions. ASPECT score is not only widely used to predict the prognosis of stroke patients, but also to identify the population benefiting from the endovascular therapy and evaluate the risk of endovascular therapy for patients. ASPECT score combined with multimodal imaging has also been used to predict ischemic core volumes and the prognosis. In recent years, with the development of artificial intelligence, automatic ASPECT scoring methods based on machine learning have emerged. This paper reviews ASPECT scoring methods, its value in the treatment and the assessment of prognosis in AIS, multimodal ASPECT scoring, and the application of automated ASPECT scoring combined with artificial intelligence.

Key words: acute ischemic stroke (AIS), Alberta stroke program early CT score (ASPECT score), prognosis, artificial intelligence

CLC Number:

R743.3

WEI Xuemin, GAO Chengjin. Research progress of clinical application of ASPECT score in acute ischemic stroke[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(7): 919-924.

TrendMD

References 39

1	HACKE W, KASTE M, FIESCHI C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS)[J]. JAMA, 1995, 274(13): 1017-1025.
2	WARDLAW J M, DORMAN P J, LEWIS S C, et al. Can stroke physicians and neuroradiologists identify signs of early cerebral infarction on CT?[J]. J Neurol Neurosurg Psychiatry, 1999, 67(5): 651-653.
3	BARBER P A, DEMCHUK A M, ZHANG J, et al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy[J]. Lancet, 2000, 355(9216): 1670-1674.
4	PUETZ V, SYLAJA P N, COUTTS S B, et al. Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion[J]. Stroke, 2008, 39(9): 2485-2490.
5	OSPEL J M, MCDONOUGH R, DEMCHUK A M, et al. Predictors and clinical impact of infarct progression rate in the ESCAPE-NA1 trial[J]. J Neurointerv Surg, 2021. DOI: 10.1136/neurintsurg-2021-017994.
6	RIOU-COMTE N, GUILLEMIN F, GORY B, et al. Predictive factors of functional independence after optimal reperfusion in anterior circulation ischaemic stroke with indication for intravenous thrombolysis plus mechanical thrombectomy[J]. Eur J Neurol, 2021, 28(1): 141-151.
7	JADHAV A P, DESAI S M, BUDZIK R F, et al. First pass effect in patients with large vessel occlusion strokes undergoing neurothrombectomy: insights from the Trevo Retriever Registry[J]. J Neurointerv Surg, 2021, 13(7): 619-622.
8	WU X, PAYABVASH S, MATOUK C C, et al. Cost-effectiveness of endovascular thrombectomy in patients with low Alberta Stroke Program Early CT Scores (<6) at presentation[J]. J Neurosurg, 2021, 135(6): 1645-1655.
9	SONG K P, GUAN M, LI W X, et al. Acute ischemic stroke patients with diffusion-weighted imaging-Alberta stroke program early computed tomography score≤5 can benefit from endovascular treatment: a single-center experience and literature review[J]. Neuroradiology, 2019, 61(4): 451-459.
10	GOYAL M, MENON B K, VAN ZWAM W H, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials[J]. Lancet, 2016, 387(10029): 1723-1731.
11	MOKIN M, PENDURTHI A, LJUBIMOV V, et al. ASPECTS, large vessel occlusion, and time of symptom onset: estimation of eligibility for endovascular therapy[J]. Neurosurgery, 2018, 83(1): 122-127.
12	TEI H, UCHIYAMA S, USUI T, et al. Diffusion-weighted ASPECTS as an independent marker for predicting functional outcome[J]. J Neurol, 2011, 258(4): 559-565.
13	KIM S K, YOON W, PARK M S, et al. Outcomes are not different between patients with intermediate and high DWI-ASPECTS after stent-retriever embolectomy for acute anterior circulation stroke[J]. AJNR Am J Neuroradiol, 2016, 37(6): 1080-1085.
14	POWERS W J, RABINSTEIN A A, ACKERSON T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2019, 50(12): e344-e418.
15	BROOCKS G, KNIEP H, SCHRAMM P, et al. Patients with low Alberta stroke program early CT score (ASPECTS) but good collaterals benefit from endovascular recanalization[J]. J Neurointerv Surg, 2020, 12(8): 747-752.
16	WANG Z X, WANG C, ZHANG P, et al. Effects of early changes in blood pressure during intravenous thrombolysis on the prognosis of acute ischemic stroke patients[J]. Front Aging Neurosci, 2020, 12: 601471.
17	INOUE M, OLIVOT J M, LABREUCHE J, et al. Impact of diffusion-weighted imaging Alberta stroke program early computed tomography score on the success of endovascular reperfusion therapy[J]. Stroke, 2014, 45(7): 1992-1998.
18	HOELTER P, MUEHLEN I, GOELITZ P, et al. Automated ASPECT scoring in acute ischemic stroke: comparison of three software tools[J]. Neuroradiology, 2020, 62(10): 1231-1238.
19	DENG P P, WU N, CHEN X J, et al. NIHSS-the Alberta stroke program early CT score mismatch in guiding thrombolysis in patients with acute ischemic stroke[J]. J Neurol, 2022, 269(3): 1515-1521.
20	WU H M, LEE I H, LUO C B, et al. Clinical-CT mismatch defined NIHSS≥8 and CT-ASPECTS≥9 as a reliable marker of candidacy for intravenous thrombolytic therapy in acute ischemic stroke[J]. PLoS One, 2021, 16(4): e0251077.
21	CLARK W, LUTSEP H, BARNWELL S, et al. The penumbra pivotal stroke trial: safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease[J]. Stroke, 2009, 40(8): 2761-2768.
22	VAN HORN N, KNIEP H, LEISCHNER H, et al. Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients[J]. J NeuroIntervent Surg, 2021, 13(1): 14-18.
23	YOSHIMOTO T, INOUE M, YAMAGAMI H, et al. Use of diffusion-weighted imaging-Alberta stroke program early computed tomography score (DWI-ASPECTS) and ischemic core volume to determine the malignant profile in acute stroke[J]. J Am Heart Assoc, 2019, 8(22): e012558.
24	LIN S F, CHEN C N, HU H H, et al. Predicting functional outcomes of posterior circulation acute ischemic stroke in first 36 h of stroke onset[J]. J Neurol, 2018, 265(4): 926-932.
25	GUILLAUME M, LAPERGUE B, GORY B, et al. Rapid successful reperfusion of basilar artery occlusion strokes with pretreatment diffusion-weighted imaging posterior-circulation ASPECTS<8 Is associated with good outcome[J]. J Am Heart Assoc, 2019, 8(10): e010962.
26	ZHANG W Y, XIANG S F, YANG S J, et al. The application of computed tomography perfusion in the Alberta stroke program early computed tomography score for endovascular treatment of acute ischemic stroke in the anterior circulation[J]. Int J Gen Med, 2021, 14: 1865-1871.
27	VOLETI S, VIDOVICH J, CORCORAN B, et al. Correlation of Alberta stroke program early computed tomography score with computed tomography perfusion core in large vessel occlusion in delayed time windows[J]. Stroke, 2021, 52(2): 498-504.
28	KUANG H, NAJM M, CHAKRABORTY D, et al. Automated ASPECTS on noncontrast CT scans in patients with acute ischemic stroke using machine learning[J]. AJNR Am J Neuroradiol, 2019, 40(1): 33-38.
29	ALBERS G W, WALD M J, MLYNASH M, et al. Automated calculation of Alberta stroke program early CT score: validation in patients with large hemispheric infarct[J]. Stroke, 2019, 50(11): 3277-3279.
30	SOUN J E, CHOW D S, NAGAMINE M, et al. Artificial intelligence and acute stroke imaging[J]. AJNR Am J Neuroradiol, 2021, 42(1): 2-11.
31	NAGANUMA M, TACHIBANA A, FUCHIGAMI T, et al. Alberta stroke program early CT score calculation using the deep learning-based brain hemisphere comparison algorithm[J]. J Stroke Cerebrovasc Dis, 2021, 30(7): 105791.
32	SALAZAR A J, USECHE N, GRANJA M, et al. Reliability and accuracy of individual Alberta stroke program early CT score regions using a medical and a smartphone reading system in a telestroke network[J]. J Telemed Telecare, 2021, 27(7): 436-443.
33	NAGEL S, WANG X, CARCEL C, et al. Clinical utility of electronic Alberta stroke program early computed tomography score software in the ENCHANTED trial database[J]. Stroke, 2018, 49(6): 1407-1411.
34	WOLFF L, BERKHEMER O A, VAN ES ACGM, et al. Validation of automated Alberta stroke program early CT score (ASPECTS) software for detection of early ischemic changes on non-contrast brain CT scans[J]. Neuroradiology, 2021, 63(4): 491-498.
35	HAUSSEN D C, DEHKHARGHANI S, RANGARAJU S, et al. Automated CT perfusion ischemic core volume and noncontrast CT ASPECTS (Alberta stroke program early CT score): correlation and clinical outcome prediction in large vessel stroke[J]. Stroke, 2016, 47(9): 2318-2322.
36	NEUHAUS A, SEYEDSAADAT S M, MIHAL D, et al. Region-specific agreement in ASPECTS estimation between neuroradiologists and e-ASPECTS software[J]. J Neurointerv Surg, 2020, 12(7): 720-723.
37	GUBERINA N, DIETRICH U, RADBRUCH A, et al. Detection of early infarction signs with machine learning-based diagnosis by means of the Alberta stroke program early CT score (ASPECTS) in the clinical routine[J]. Neuroradiology, 2018, 60(9): 889-901.
38	DO L N, BAEK B H, KIM S K, et al. Automatic assessment of ASPECTS using diffusion-weighted imaging in acute ischemic stroke using recurrent residual convolutional neural network[J]. Diagnostics, 2020, 10(10): 803.
39	MAEGERLEIN C, FISCHER J, MÖNCH S, et al. Automated calculation of the Alberta stroke program early CT score: feasibility and reliability[J]. Radiology, 2019, 291(1): 141-148.

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