Title : Precision prognostication of long-term outcomes in acute ischemic stroke based on aspects lesion core quantification
Abstract:
Objective: The ASPECTS score serves as a semi-quantitative instrument for assessing acute ischemic strokes within the middle cerebral artery (MCA-AIS) territory, and DWI-ASPECTS has been found to exhibit superior sensitivity and precision. The primary objective of this study was to devise a model that leverages the volumes of lesion cores within the ASPECTS-defined regions (ASPECTS-VolDWI), as inferred from diffusion-weighted imaging (DWI), along with conventional multi-clinical parameters, to precisely forecast long-term functional outcomes in patients with MCA-AIS.
Methods: This multicenter retrospective study included 464 MCA-AIS patients who met the inclusion criteria. ASPECTS-VolDWI was obtained using RealNow software based on DWI images. The 90-day modified Rankin Scale (90d-mRS) score was employed as the benchmark for categorizing long-term functional outcomes, with an mRS score of ≤2 indicating a favorable outcome and an mRS score of >2 indicating an unfavorable outcome. Statistical evaluations were performed using R statistical software (version 4.2.1).
Results: The logistic regression model that integrated ASPECTS-Vol and Multi-clinical variables demonstrated the highest predictive efficacy, with an area under the curve (AUC) of 0.878 (95% confidence interval [CI]: 0.847-0.909), a sensitivity of 0.8075 (95% CI: 0.744-0.861), a specificity of 0.810 (95% CI: 0.759-0.855), and an accuracy of 0.809 (95% CI: 0.769-0.849). DeLong’s test indicated that the combined ASPECTS-VolDWI + Multi-clinics model significantly surpassed the performance of both the ASPECTS-VolDWI model (p<0.001) and the Multi-clinics model (p<0.001). The nomogram constructed revealed that age, baseline National Institutes of Health Stroke Scale (NIHSS) score, and the volume of infarcts in the lentiform nucleus, caudate nucleus, and posterior limb of the internal capsule were the most influential predictive factors.
Conclusion: This investigation presents a refined method for quantifying the lesion core volumes within the ASPECTS regions, which are crucial quantitative imaging markers for assessing the severity of MCA-AIS, guiding treatment strategies, and forecasting outcomes with enhanced accuracy. Additionally, by incorporating a range of clinical variables, this study develops and visualizes a predictive model that facilitates the prognostication of long-term outcomes in patients with MCA-AIS.
Keywords: Middle Cerebral Artery - Acute Ischemic Stroke (MCA-AIS), Diffusion-Weighted Imaging (DWI), ASPECTS Score, Lesion Core Quantification, Prognostic Prediction
Audience Take Away Notes:
- Enhanced Precision in Stroke Assessment: This enhanced precision may lead to more accurate prognostications and tailored treatment plans
- Integration of Clinical and Imaging Variables: This integration potentially offers a more holistic understanding of stroke severity and long-term outcomes
- Prognostic Value for Treatment and Planning: This tool can aid clinicians in making informed decisions about treatment strategies and resource allocation, potentially improving patient outcomes and optimizing the use of healthcare resources
