Introduction: Multiphase CT-Angiography (mCTA) can provide dynamic parenchymal hemodynamic information, including proper microvascular ‘blood pool’ assessment. Our objective was to determine which ASPECTS scoring method between non-contrast CT (NCCT), and delayed phase blood pool assessment on mCTA best predicted final infarct. This can contribute to decision making for endovascular therapy.
Hypothesis: ASPECTS on delayed phase blood pool analysis would best predict final infarct score.
Methods: Patients with TICI 0, 2b, or 3 reperfusion who met criteria for thrombolysis and endovascular therapy were included. ASPECTS scores were calculated on admission NCCT. Blood pool ASPECTS were calculated as discrete areas of hypodensity on delayed phase mCTA. Baseline scores were compared to final infarct score on follow-up CT/MRI. Sensitivities and specificities were calculated and then stratified by brain region to determine the most predictive method.
Results: Fifty-three patients were analyzed (25/53= TICI 0, 10/53= TICI 2b, 15/53= TICI 3). Delayed phase blood pool mCTA showed similar sensitivities for ganglionic regions and improved sensitivities for supraganglionic regions. Delayed phase blood pool analysis of mCTA showed improved specificity in ganglionic regions over NCCT (Table 1, Figure 1).
Conclusion: In conclusion, blood pool assessment on delayed phase mCTA has the capability to identify additional at risk tissue beyond that defined by NCCT.