Low Alberta Stroke Program Early CT Score (ASPECTS) Associated with Malignant Middle Cerebral Artery Infarction
Low Alberta Stroke Program Early CT Score (ASPECTS) Associated with Malignant Middle Cerebral Artery Infarction
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DOI：
10.1159/000363619
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发表时间：
2014-09-01
影响因子：
2.9
通讯作者：
Yan, Bernard
中科院分区：
文献类型：
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作者：
MacCallum, Caroline;Churilov, Leonid;Yan, Bernard
背景：恶性大脑中动脉(MCA)梗死后早期半颅骨减压术可降低死亡率，改善临床预后。恶性脑梗塞的影像预测指标可能起到“危险信号”的作用，促使加强神经监测和及时干预。我们的目标是调查低方面(艾伯塔省卒中计划早期CT评分)是否与恶性大脑中动脉梗死相关。方法：对2009年1月1日至2009年12月31日在皇家墨尔本医院(RMH)住院的所有MCA区缺血性卒中患者(包括226名患者)进行回顾性队列研究。主要观察指标为每个患者的入院情况和恶性大脑中动脉梗死的进展情况。结果：108例(48%)患者发生恶性大脑中动脉梗死。使用加权kappa、类内相关系数和林氏一致性系数观察到观察者得分方面的评分者间一致性良好(>；0.8)。通过受试者工作特征(ROC)曲线分析，我们验证了Aspects 7是判断进展为恶性梗死的最佳分界点，提供50%的敏感性和86%的特异性。156名患者有Aspects；7(69%)，70名患者有Aspects
Background: Early decompressive hemicraniectomy following malignant middle cerebral artery (MCA) infarction reduces mortality and improves clinical outcome. Imaging predictors of malignant infarction may serve as 'red flags', prompting intensive neurological monitoring and timely intervention. Our objective is to investigate whether lower ASPECTS (Alberta Stroke Program Early CT Score) is associated with malignant MCA infarction. Methods: A retrospective cohort study of all patients with MCA territory ischemic strokes who were admitted to the Royal Melbourne Hospital (RMH) between 1 January 2009 and 31 December 2009 (226 patients included). The main outcome measures were ASPECTS on admission for each patient and the development of malignant MCA infarction. Results: One-hundred-and-eight patients out of 226 (48%) developed malignant MCA infarction. Good (>0.8) inter-rater agreement between observers scoring ASPECTS was observed using weighted kappa, intra-class correlation coefficient and Lin's concordance coefficients. Using receiver operating characteristic (ROC) curve analysis, we validated that ASPECTS 7 was the optimal cut-off score to determine progression to malignant infarction, providing 50% sensitivity and 86% specificity. One hundred and fifty six patients had ASPECTS >7 (69%) and 70 patients had ASPECTS