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已发表论文
双能 CT 显示对比剂外渗的改良艾伯塔省卒中项目早期 CT 评分（ASPECTS）可预测血管内血栓切除术后出血性转化及不良预后
Authors Chen X , Xu J, Zhang S, Guo S, Wang H, Shang Y, Shen P , Ye J, Geng Y
Received 7 May 2025
Accepted for publication 13 November 2025
Published 1 December 2025 Volume 2025:21 Pages 1603—1614
DOI https://doi.org/10.2147/TCRM.S522244
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor De Yun Wang
Xinyi Chen,1 Jie Xu,2 Sheng Zhang,3 Shunyuan Guo,3 Huiyuan Wang,3 Yafei Shang,3 Panpan Shen,3 Jiawei Ye,3 Yu Geng3
1Department of Neurology, The Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People’s Republic of China; 2Department of neurology, Huzhou Central Hospital, Huzhou, Zhejiang, People’s Republic of China; 3Department of Neurology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, People’s Republic of China
Correspondence: Yu Geng, Department of Neurology, Zhejiang Provincial People’s Hospital, 158# Shangtang Road, Hangzhou, Zhejiang, 310014, People’s Republic of China, Email gengyu@hmc.edu.cn
Purpose: Haemorrhagic transformation (HT) is an unpredictable complication of acute ischaemic stroke with large vessel occlusion following endovascular thrombectomy (EVT), and imaging parameters that are correlated with haemorrhage are unknown. We developed a modified version of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) by adding a periventricular region to assess cerebral contrast extravasation (CE) on dual-energy computed tomography (DECT) and assessed its predictive value for HT.
Methods: In total, 101 patients who underwent DECT immediately after EVT were prospectively enrolled. CE was defined as incident hyperdensity on iodine overlay maps. We quantified the CT attenuation in Hounsfield units (HU) and iodine concentration within the CE regions. The modified ASPECTS divided the middle cerebral artery vascular territory into 11 regions and added one region (paraventricular) to the original score. CE was scored as 1 point for each region, and the cumulative score was determined. Follow-up imaging was performed within 7 days postoperatively to confirm the occurrence of HT. A receiver operating characteristic (ROC) curve was constructed to assess the predictive value of various DECT-measured parameters for HT.
Results: Overall, 75/101 (74.3%) patients exhibited CE following EVT, and 47/101 (46.5%) patients exhibited HT. In the ROC curve analysis, the DECT parameter with the maximal area under the curve (AUC) for HT was the modified ASPECTS (AUC=0.87), indicating that patients with a modified ASPECTS > 2 were more likely to develop HT (sensitivity: 83.0%, specificity: 83.3%). The maximum iodine concentration (AUC=0.76) and maximum CT attenuation (AUC=0.68) in the hyperdense region were also predictors of postoperative HT.
Conclusion: The modified ASPECTS is a practical and sensitive method for assessing postoperative HT risk in patients following EVT.
Keywords: dual-energy computed tomography, endovascular thrombectomy, ASPECTS, haemorrhagic transformation
1Department of Neurology, The Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People’s Republic of China; 2Department of neurology, Huzhou Central Hospital, Huzhou, Zhejiang, People’s Republic of China; 3Department of Neurology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, People’s Republic of China
Correspondence: Yu Geng, Department of Neurology, Zhejiang Provincial People’s Hospital, 158# Shangtang Road, Hangzhou, Zhejiang, 310014, People’s Republic of China, Email gengyu@hmc.edu.cn
Purpose: Haemorrhagic transformation (HT) is an unpredictable complication of acute ischaemic stroke with large vessel occlusion following endovascular thrombectomy (EVT), and imaging parameters that are correlated with haemorrhage are unknown. We developed a modified version of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) by adding a periventricular region to assess cerebral contrast extravasation (CE) on dual-energy computed tomography (DECT) and assessed its predictive value for HT.
Methods: In total, 101 patients who underwent DECT immediately after EVT were prospectively enrolled. CE was defined as incident hyperdensity on iodine overlay maps. We quantified the CT attenuation in Hounsfield units (HU) and iodine concentration within the CE regions. The modified ASPECTS divided the middle cerebral artery vascular territory into 11 regions and added one region (paraventricular) to the original score. CE was scored as 1 point for each region, and the cumulative score was determined. Follow-up imaging was performed within 7 days postoperatively to confirm the occurrence of HT. A receiver operating characteristic (ROC) curve was constructed to assess the predictive value of various DECT-measured parameters for HT.
Results: Overall, 75/101 (74.3%) patients exhibited CE following EVT, and 47/101 (46.5%) patients exhibited HT. In the ROC curve analysis, the DECT parameter with the maximal area under the curve (AUC) for HT was the modified ASPECTS (AUC=0.87), indicating that patients with a modified ASPECTS > 2 were more likely to develop HT (sensitivity: 83.0%, specificity: 83.3%). The maximum iodine concentration (AUC=0.76) and maximum CT attenuation (AUC=0.68) in the hyperdense region were also predictors of postoperative HT.
Conclusion: The modified ASPECTS is a practical and sensitive method for assessing postoperative HT risk in patients following EVT.
Keywords: dual-energy computed tomography, endovascular thrombectomy, ASPECTS, haemorrhagic transformation