Background: Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is a quantitative score to evaluate early ischemic changes in the middle cerebral arterial territory on Computed Tomography (CT) in addition to diffusion-weighted imaging (DWI).
Aim: To study the value of ASPECTS using CT and DWI-MRI in patients with acute stroke related to middle cerebral artery (MCA) territories and their values in predicting hemorrhagic transformation (HT).
Methods and Materials: A prospective study was done at Al-Imamain Al-Kadhmain Medical City in Baghdad, Iraq from January 2017 to January 2018 and conducted on 100 patients (62 male, 38 female) who had acute ischemic stroke related to MCA territories and imaged with CT and Magnetic Resonance Imaging (MRI) within 6 hours of symptoms onset.
Results: Male: Female ratio 1.6:1, mean age 58.7 ± 11.78 years, the mean of time between onset of symptoms and CT scan was 165 minutes. The difference between CT and DWI ASPECTS was about one point. CT scan signs of early ischemic changes were found in 58% of the patients while DWI-MRI signs of early ischemic changes were recognized in 75% patients (significance level P=0.011). The overall sensitivity and specificity of CT ASPECTS compared to MRI-DWI was 82.86% and 83.37% respectively and the accuracy was 83.00%, 70 patients had follow up by another MRI to detect HT, patients with low ASPECTS had more tendency to exhibit HT.
Conclusion: ASPECTS is a simple applicable tool for early accurate recognition and standardizing the reporting evaluation of acute ischemic stroke related to MCA territories. DWI-ASPECTS scored were roughly one point lower than CT-ASPECTS. Although CT-ASPECTS and DWI-ASPECTS were valuable in predicting symptomatic HT, DWIASPECTS are more sensitive.