E-Aspects derived acute ischemic volumes on non-contrast enhanced computed tomography images correlate with diffusion weighted imaging lesion volumes and predict clinical outcome in acute ischemic stroke patients

Background and Purpose: e-ASPECTS derived automated acute ischemic volume (AAIV) measurements on non-contrast computed tomography (NCCT) were correlated with clinical variables and diffusion weighted lesion volumes (DWI) in acute ischemic stroke patients.Methods: Data from three studies were reanalyzed with e-ASPECTS Version 7. The National Institute of Health Stroke Scale (NIHSS) determined stroke severity at baseline and clinical outcome was measured with the modified Rankin Scale (mRS) between 45 to 120 days. Spearman ranked correlation coefficients (R) of AAIV and e-ASPECTS scores with DWI lesion volumes, NIHSS and mRS were calculated. Multivariate regression analysis (odds ratio, OR with 95% confidence intervals, CI) and receiver operating characteristic (ROC) curve analysis (area under the curve, AUC with 95% CI) with regard to good outcome (mRS 0-2) were performed.Results: In total 388 patients were included. Median AAIV was 33.5+/-24.9 ml, (interquartile range) e-ASPECTS was 9 (8-10) and mean time to scan was 155+/-119 minutes. AAIV and e-ASPECTS correlated strongly (R=-0.78, p<0.001), and AAIV, respectively e-ASPECTS correlated with NIHSS (R=0.33, p<0.001; R=-0.35, p<0.001) and mRS (R=0.31, p<0.001; R=-0.31, p<0.001). AAIV correlated strongly with DWI lesion volume (n=37, R=0.69, p<0.001). AAIV (OR 0.98 per ml, 95% CI 0.97-0.99) was an independent predictor of good outcome, and 29.8 ml (AUC: 0.67, 0.61-0.71) was the optimal cut-off for good outcome.Conclusion: AAIV on NCCT is a new feature of the e-ASPECTS software, which significantly correlates with clinical severity and clinical outcome as well as DWI lesion volumes