Objectives

Individual subcortical infarct scoring for the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) can be difficult and is subjected to higher inter-reader variability. This study compares performance of the 10-point ASPECTS with a new 7-point cortically-weighted score in predicting post-thrombectomy functional outcomes.

Materials and Methods: Prospective registry data from two comprehensive stroke centers (Site 1

2016-2021; Site 2: 2019-2021) included patients with either M1 segment of middle cerebral artery or internal carotid artery occlusions who underwent thrombectomy. Two multivariate proportional odds training models utilizing either 10-point or 7-point ASPECTS predicting 90-day shift in modified Rankin score were generated using Site 1 data and validated with Site 2 data. Models were compared using multiclass receiver operator characteristics, corrected Akaike's Information Criterion, and likelihood ratio test.

Results

Of 328 patients (Site 1 = 181, Site 2 = 147), median age was 71y (IQR 61-82), 119 (36%) had internal carotid artery occlusions, and median 10-point ASPECTS was 9 (IQR 8-10). There was no difference in performance between models using either total or cortically-weighted ASPECTS (p=0.14). Validation cohort data were correctly (i.e., predicting modified Rankin score within one point) classified 50% (cortically-weighted score model) and 56% (total score model) of the time.

Conclusions

The 7-point cortically-weighted ASPECTS was similarly predictive of post-thrombectomy functional outcome as 10-point ASPECTS. Given noninferior performance, the cortically-weighted score is a potentially reliable, but simplified, alternative to the traditional scoring paradigm, with potential implications in automated image analysis tool development.

中文翻译：

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血栓切除结果模型中的皮质加权与阿尔伯塔总卒中计划早期计算机断层扫描评分

目标

艾伯塔省中风计划早期计算机断层扫描评分 (ASPECTS) 的个体皮层下梗死评分可能很困难，并且读者间的变异性较高。本研究比较了 10 分 ASPECTS 与新的 7 分皮质加权评分在预测血栓切除术后功能结果方面的表现。

材料和方法：来自两个综合性卒中中心的前瞻性登记数据（站点 1）

2016-2021；站点 2：2019-2021）包括接受血栓切除术的大脑中动脉 M1 段或颈内动脉闭塞的患者。使用站点 1 数据生成两个多元比例赔率训练模型，利用 10 点或 7 点 ASPECTS 预测修改后的 Rankin 评分的 90 天变化，并使用站点 2 数据进行验证。使用多类接收者操作员特征、修正的 Akaike 信息准则和似然比检验来比较模型。

结果

在 328 名患者（部位 1 = 181，部位 2 = 147）中，中位年龄为 71 岁（IQR 61-82），119 名（36%）患有颈内动脉闭塞，中位 10 点 ASPECTS 为 9（IQR 8-10） ）。使用总 ASPECTS 或皮质加权 ASPECTS 的模型之间的性能没有差异 (p=0.14)。验证队列数据正确分类的概率为 50%（皮质加权评分模型）和 56%（总评分模型）（即，预测修改后的 Rankin 评分在 1 分之内）。

结论

7 点皮质加权 ASPECTS 对血栓切除术后功能结果的预测与 10 点 ASPECTS 类似。鉴于性能不差，皮质加权评分是传统评分范例的一种潜在可靠但简化的替代方案，对自动图像分析工具的开发具有潜在影响。