ASPECTS-based net water uptake as an imaging biomarker for lesion age in acute ischemic stroke

Objective: We assessed the value of computed tomography (CT) and automated Alberta Stroke Program Early CT Score (ASPECTS) with net water uptake (NWU) to predict stroke onset time.

Methods: Two-hundred forty stroke patients with anterior circulation large-vessel occlusion were included. CT-ASPECTS-NWU values were calculated by comparing the mean Hounsfield units of affected ASPECTS regions with unaffected contralateral regions. The correlation between ASPECTS-NWU and stroke onset to CT time was assessed. ASPECTS-NWU predictive values were calculated to identify a stroke onset to CT time of within 4.5/6 h.

Results: A correlation existed between stroke onset to CT time and ASPECTS-NWU (r = 0.65, p < 0.001), which was affected by collateral status and infarct location. The area under the receiver operating characteristic (ROC) curve (AUC) for distinguishing a stroke onset to CT time of within 4.5 h was 0.837 (95% confidence interval [CI] 0.784-0.881; optimal cutoff 7%; sensitivity 87.10%; specificity 62.36%). The multi-index AUC was 0.884 (95% CI 0.837-0.922). The AUC for distinguishing a stroke onset to CT time of within 6 h was 0.836 (95% CI 0.783-0.880; optimal cutoff 9%; sensitivity 72.73%; specificity 81.16%). The multi-index AUC was 0.881 (95% CI 0.834-0.920).

Conclusions: ASPECTS-NWU may be used to determine stroke onset time in patients with unwitnessed or wake-up stroke.