ASPECTS and Other Neuroimaging Scores in the Triage and Prediction of Outcome in Acute Stroke Patients

Brain imaging has revolutionized the treatment of patients with acute ischemic stroke. With the visual differentiation of hemorrhagic from ischemic stroke, thrombolytic therapy became feasible. The effort since then has been to use imaging techniques to help determine which patients would benefit most with thrombolytic therapy. With the availability of endovascular techniques capable of opening an occludedarteryfasterthanintravenous(IV)recombinant tissue plasminogen activator (rtPA), imaging techniques have also been used to tailor therapy appropriate to a patient. This review summarizes current knowledge on the Alberta Stroke Program Early CT Score (ASPECTS) and other neuroimaging scores that help a clinician determine prognosis and decide on appropriate therapy in patients presenting with acute ischemic strokes. ASPECTS In the National Institute of Neurological Disorders and Stroke (NINDS) rtPA Stroke Study, computed tomography (CT) was used as a screening tool to exclude intracranial hemorrhage (ICH) before rtPA administration. The extent of early ischemic changes (EIC) on the baseline CT scan did not influence patient eligibility. 1 Initial EIC definition was based on edema and mass effect. A total of 5.2% patients had evidence of such findings. Their presence was associated with a higher risk of symptomatic intracranial hemorrhage (sICH); however, no treatment-modifying effect was demonstrated. 2 A more detailed re-review of the NINDSrtPAStrokeStudyscansresultedinahigher prevalence of EIC (31%), largely due to a differing