Impact of slice thickness on clinical utility of automated Alberta Stroke Program Early Computed Tomography Scores

Objectives: e-ASPECTS has been shown to quantify acute ischemic infarction reliably. This study validates the impact of CT slice thickness (ST) on its performance.

Methods: A cohort of 258 patients with middle cerebral artery occlusion treated with mechanical thrombectomy was analyzed. e-ASPECTS scores and infarct volumes were calculated from baseline non-contrast CT using 1-mm ST (ground truth) and axial reconstructions with 2–10-mm ST, then correlated with baseline NIHSS and 90-day mRS using logistic regression.

Results: Significant differences in e-ASPECTS scores emerged with ST >6 mm and in infarct volumes with ST >4 mm. Lower e-ASPECTS and higher infarct volumes correlated with increasing NIHSS across all STs, with 1-mm ST showing the strongest correlation, and were linked to poor 90-day outcomes, with 1-mm ST providing the strongest predictive value.

Conclusions: e-ASPECTS provides robust assessments with ST ≤4 mm, with 1-mm ST offering the highest accuracy in predicting stroke severity and clinical outcomes.