e-ASPECTS derived acute ischemic volumes on non-contrast-enhanced computed tomography images

Background and purpose: Validation of automatically derived acute ischemic volumes (AAIV) from e-ASPECTS on non-contrast computed tomography (NCCT).

Materials and methods: Data from three studies were reanalyzed with e-ASPECTS Version 7. AAIV was calculated in ml across all scored ASPECTS regions detected by e-ASPECTS. NIHSS determined baseline stroke severity and mRS measured clinical outcome at 45–120 days. Correlations of AAIV and e-ASPECTS with NIHSS, mRS, and DWI/CTP-estimated ischemic core volumes were calculated, with multivariate regression and Bland–Altman analysis.

Results: 388 patients were included; mean AAIV was 11.6 ± 18.9 ml and median e-ASPECTS was 9. AAIV and e-ASPECTS correlated with baseline NIHSS and follow-up mRS. AAIV correlated strongly with DWI (R = 0.68) and CTP-derived core (R = 0.76) lesion volume, with bias close to zero. Both AAIV (OR 0.98 per ml) and e-ASPECTS (OR 1.3) were independent predictors of good outcome.

Conclusion: AAIV on NCCT correlated moderately with clinical severity but strongly with DWI lesion and CTP ischemic core volumes, and predicted clinical outcome.