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

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 Thomalla, Gregory Albers, Stephen Davis, Geoffrey DonnanMarc Fisher, Anthony Furlan, James Grotta, Werner Hacke, Chelsea Kidwell, Walter Koroshetz, Kennedy R. Lees, Michael Lev, A. Gregory Sorensen, Vincent Thijs, Joanna Wardlaw, Max Wintermark Götz Thomalla, Qing Hao, Jong S. Kim, Lorenz Breuer, Andras Treszl, Nils D. Forkert, Ivana Galinovic, Michael Rosenkranz, Tobias Engelhorn, Matthias Endres, Vincent Dousset

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background and Purpose - 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 DWIASPECTS 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.

Methods - We analyzed data of patients with MCA stroke from a prospective observational study of DWI and fluidattenuated 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.

Results - A total of 496 patients were included. There was a significant negative correlation between ASPECTS and DWI lesion volume (r=-0.78; P<0.0001). With regards to lesion localization, correlation was weaker in deep MCA region (r=-0.19; P=0.038) when compared with superficial (r=-0.72; P<0.001) or combined superficial and deep MCA lesions (r=-0.72; P<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).

Conclusions - 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.

Original languageEnglish (US)
Pages (from-to)3583-3588
Number of pages6
JournalStroke
Volume45
Issue number12
DOIs
StatePublished - Dec 11 2014

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Alberta
Middle Cerebral Artery Infarction
Stroke Volume
Stroke
Middle Cerebral Artery
ROC Curve
Observational Studies

Keywords

  • Brain ischemia
  • Diffusion magnetic resonance imaging
  • Magnetic resonance imaging
  • Middle cerebral artery
  • Neuroimaging
  • Severity of illness index
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing
  • Medicine(all)

Cite this

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. / Schröder, Julian; Cheng, Bastian; Ebinger, Martin; Köhrmann, Martin; Wu, Ona; Kang, Dong Wha; Liebeskind, David S.; Tourdias, Thomas; Singer, Oliver C.; Christensen, Soren; Campbell, Bruce; Luby, Marie; Warach, Steven; Fiehler, Jens; Fiebach, Jochen B.; Gerloff, Christian; Thomalla, Götz; Albers, Gregory; Davis, Stephen; Donnan, Geoffrey; Fisher, Marc; Furlan, Anthony; Grotta, James; Hacke, Werner; Kidwell, Chelsea; Koroshetz, Walter; Lees, Kennedy R.; Lev, Michael; Sorensen, A. Gregory; Thijs, Vincent; Wardlaw, Joanna; Thomalla, Max Wintermark Götz; Hao, Qing; Kim, Jong S.; Breuer, Lorenz; Treszl, Andras; Forkert, Nils D.; Galinovic, Ivana; Rosenkranz, Michael; Engelhorn, Tobias; Endres, Matthias; Dousset, Vincent.

In: Stroke, Vol. 45, No. 12, 11.12.2014, p. 3583-3588.

Research output: Contribution to journalArticle

Schröder, J, Cheng, B, Ebinger, M, Köhrmann, M, Wu, O, Kang, DW, Liebeskind, DS, Tourdias, T, Singer, OC, Christensen, S, Campbell, B, Luby, M, Warach, S, Fiehler, J, Fiebach, JB, Gerloff, C, Thomalla, G, Albers, G, Davis, S, Donnan, G, Fisher, M, Furlan, A, Grotta, J, Hacke, W, Kidwell, C, Koroshetz, W, Lees, KR, Lev, M, Sorensen, AG, Thijs, V, Wardlaw, J, Thomalla, MWG, Hao, Q, Kim, JS, Breuer, L, Treszl, A, Forkert, ND, Galinovic, I, Rosenkranz, M, Engelhorn, T, Endres, M & Dousset, V 2014, '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', Stroke, vol. 45, no. 12, pp. 3583-3588. https://doi.org/10.1161/STROKEAHA.114.006694
Schröder, Julian ; Cheng, Bastian ; Ebinger, Martin ; Köhrmann, Martin ; Wu, Ona ; Kang, Dong Wha ; Liebeskind, David S. ; Tourdias, Thomas ; Singer, Oliver C. ; Christensen, Soren ; Campbell, Bruce ; Luby, Marie ; Warach, Steven ; Fiehler, Jens ; Fiebach, Jochen B. ; Gerloff, Christian ; Thomalla, Götz ; Albers, Gregory ; Davis, Stephen ; Donnan, Geoffrey ; Fisher, Marc ; Furlan, Anthony ; Grotta, James ; Hacke, Werner ; Kidwell, Chelsea ; Koroshetz, Walter ; Lees, Kennedy R. ; Lev, Michael ; Sorensen, A. Gregory ; Thijs, Vincent ; Wardlaw, Joanna ; Thomalla, Max Wintermark Götz ; Hao, Qing ; Kim, Jong S. ; Breuer, Lorenz ; Treszl, Andras ; Forkert, Nils D. ; Galinovic, Ivana ; Rosenkranz, Michael ; Engelhorn, Tobias ; Endres, Matthias ; Dousset, Vincent. / 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. In: Stroke. 2014 ; Vol. 45, No. 12. pp. 3583-3588.
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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",
abstract = "Background and Purpose - 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 DWIASPECTS 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.Methods - We analyzed data of patients with MCA stroke from a prospective observational study of DWI and fluidattenuated 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.Results - A total of 496 patients were included. There was a significant negative correlation between ASPECTS and DWI lesion volume (r=-0.78; P<0.0001). With regards to lesion localization, correlation was weaker in deep MCA region (r=-0.19; P=0.038) when compared with superficial (r=-0.72; P<0.001) or combined superficial and deep MCA lesions (r=-0.72; P<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).Conclusions - 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.",
keywords = "Brain ischemia, Diffusion magnetic resonance imaging, Magnetic resonance imaging, Middle cerebral artery, Neuroimaging, Severity of illness index, Stroke",
author = "Julian Schr{\"o}der and Bastian Cheng and Martin Ebinger and Martin K{\"o}hrmann and Ona Wu and Kang, {Dong Wha} and Liebeskind, {David S.} and Thomas Tourdias and Singer, {Oliver C.} and Soren Christensen and Bruce Campbell and Marie Luby and Steven Warach and Jens Fiehler and Fiebach, {Jochen B.} and Christian Gerloff and G{\"o}tz Thomalla and Gregory Albers and Stephen Davis and Geoffrey Donnan and Marc Fisher and Anthony Furlan and James Grotta and Werner Hacke and Chelsea Kidwell and Walter Koroshetz and Lees, {Kennedy R.} and Michael Lev and Sorensen, {A. Gregory} and Vincent Thijs and Joanna Wardlaw and Thomalla, {Max Wintermark G{\"o}tz} and Qing Hao and Kim, {Jong S.} and Lorenz Breuer and Andras Treszl and Forkert, {Nils D.} and Ivana Galinovic and Michael Rosenkranz and Tobias Engelhorn and Matthias Endres and Vincent Dousset",
year = "2014",
month = "12",
day = "11",
doi = "10.1161/STROKEAHA.114.006694",
language = "English (US)",
volume = "45",
pages = "3583--3588",
journal = "Stroke",
issn = "0039-2499",
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number = "12",

}

TY - JOUR

T1 - 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

AU - Schröder, Julian

AU - Cheng, Bastian

AU - Ebinger, Martin

AU - Köhrmann, Martin

AU - Wu, Ona

AU - Kang, Dong Wha

AU - Liebeskind, David S.

AU - Tourdias, Thomas

AU - Singer, Oliver C.

AU - Christensen, Soren

AU - Campbell, Bruce

AU - Luby, Marie

AU - Warach, Steven

AU - Fiehler, Jens

AU - Fiebach, Jochen B.

AU - Gerloff, Christian

AU - Thomalla, Götz

AU - Albers, Gregory

AU - Davis, Stephen

AU - Donnan, Geoffrey

AU - Fisher, Marc

AU - Furlan, Anthony

AU - Grotta, James

AU - Hacke, Werner

AU - Kidwell, Chelsea

AU - Koroshetz, Walter

AU - Lees, Kennedy R.

AU - Lev, Michael

AU - Sorensen, A. Gregory

AU - Thijs, Vincent

AU - Wardlaw, Joanna

AU - Thomalla, Max Wintermark Götz

AU - Hao, Qing

AU - Kim, Jong S.

AU - Breuer, Lorenz

AU - Treszl, Andras

AU - Forkert, Nils D.

AU - Galinovic, Ivana

AU - Rosenkranz, Michael

AU - Engelhorn, Tobias

AU - Endres, Matthias

AU - Dousset, Vincent

PY - 2014/12/11

Y1 - 2014/12/11

N2 - Background and Purpose - 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 DWIASPECTS 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.Methods - We analyzed data of patients with MCA stroke from a prospective observational study of DWI and fluidattenuated 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.Results - A total of 496 patients were included. There was a significant negative correlation between ASPECTS and DWI lesion volume (r=-0.78; P<0.0001). With regards to lesion localization, correlation was weaker in deep MCA region (r=-0.19; P=0.038) when compared with superficial (r=-0.72; P<0.001) or combined superficial and deep MCA lesions (r=-0.72; P<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).Conclusions - 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.

AB - Background and Purpose - 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 DWIASPECTS 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.Methods - We analyzed data of patients with MCA stroke from a prospective observational study of DWI and fluidattenuated 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.Results - A total of 496 patients were included. There was a significant negative correlation between ASPECTS and DWI lesion volume (r=-0.78; P<0.0001). With regards to lesion localization, correlation was weaker in deep MCA region (r=-0.19; P=0.038) when compared with superficial (r=-0.72; P<0.001) or combined superficial and deep MCA lesions (r=-0.72; P<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).Conclusions - 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.

KW - Brain ischemia

KW - Diffusion magnetic resonance imaging

KW - Magnetic resonance imaging

KW - Middle cerebral artery

KW - Neuroimaging

KW - Severity of illness index

KW - Stroke

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U2 - 10.1161/STROKEAHA.114.006694

DO - 10.1161/STROKEAHA.114.006694

M3 - Article

C2 - 25316278

AN - SCOPUS:84922480863

VL - 45

SP - 3583

EP - 3588

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 12

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