ASPECTS v.1

Alberta Stroke Program Early CT Score (ASPECTS) determines MCA stroke severity using available CT data.

Therese Lindberg

therese.lindberg@cambio.se

Cambio CDS

Determines MCA stroke severity using available CT data. Identifying patients with a greater likelihood of poor functional outcome (scores <8) may be helpful in the early stages of care for supporting transfer or therapy decisions.

Use when patients presenting in the first minutes and hours of a stroke with clinical suspicion for middle cerebral artery occlusion. The ASPECTS relies on subtle CT findings and thus requires an experienced radiologist. Its only validated use is as a binary variable (<8 vs ≥8) for general outcome prediction in those eligible for reperfusion therapy. For patients being considered for intra-arterial tPA administration, ASPECTS may be useful to exclude patients not likely to do well in terms of functional independence (i.e., intra-arterial treatment likely to be futile). To compute the ASPECTS, 1 point is subtracted from 10 for any evidence of early ischemic change for each of the defined regions. A normal CT scan receives an ASPECTS of 10 points. An ASPECTS of ≤7 points highly correlates with negative functional outcome, determined by Modified Rankin Scale (mRS). An ASPECTS of 0 indicates diffuse involvement throughout the MCA territory. Subcortical structures are allotted 3 points (C, L, and IC). MCA cortex is allotted 7 points (insular cortex, M1, M2, M3, M4, M5, and M6). ASPECTS has mainly been studied in patients treated with or eligible for stroke reperfusion therapy (tPA), which many stroke patients do not qualify for.

The score does not consistently predict treatment response or intracranial hemorrhage or offer nuanced prognostic information.

1. Barber PA, Demchuk AM, Zhang J et-al. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet. 2000;355 (9216): 1670-4.

EVALUATION.aspects.v0