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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleAdult Brain

Location-Specific ASPECTS Paradigm in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

S.M. Seyedsaadat, A.A. Neuhaus, J.M. Pederson, W. Brinjikji, A.A. Rabinstein and D.F. Kallmes
American Journal of Neuroradiology November 2020, 41 (11) 2020-2026; DOI: https://doi.org/10.3174/ajnr.A6847
S.M. Seyedsaadat
aFrom the Department of Radiology (S.M.S., W.B., D.F.K.)
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A.A. Neuhaus
cMedical School (A.A.N.), University of Oxford, Oxford, England
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J.M. Pederson
dDepartment of Veterinary and Biomedical Sciences (J.M.P.), University of Minnesota, Minneapolis, Minnesota
eSuperior Medical Experts (J.M.P.), St. Paul, Minnesota
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W. Brinjikji
aFrom the Department of Radiology (S.M.S., W.B., D.F.K.)
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A.A. Rabinstein
bDepartment of Neurology (A.A.R.), Mayo Clinic, Rochester, Minnesota.
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D.F. Kallmes
aFrom the Department of Radiology (S.M.S., W.B., D.F.K.)
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Article Figures & Data

Figures

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  • FIG 1.
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    FIG 1.

    Flow diagram depicting the literature review, search strategy, and selection process using the PRISMA guidelines.

  • FIG 2.
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    FIG 2.

    Topography and outcome brain map generated using the β-coefficients from pooled ORs for each region based on the random-effects model, indicating the relative weight of each ASPECTS region to M6, which was determined to be the region with greatest significant association with poor outcomes. The ASPECTS region most strongly associated with poor neurologic outcome was assigned a value of 1.0, and the remaining regions were assigned values relative to the maxima and according to their respective β-coefficients. Reprinted with permission from Barber et al.34 C indicates caudate nucleus; L, lentiform nucleus; IC, internal capsule; I, insula.

  • FIG 3.
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    FIG 3.

    Forest plots demonstrating the contribution of individual ASPECTS regions, with 90-day functional outcome based on collective data of the 9 included studies.

  • FIG 4.
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    FIG 4.

    Topography and outcome brain map generated using the β-coefficients from pooled ORs for each region based on NCCT ASPECTS studies. Note that data shown are calculated from both hemispheres but are displayed unilaterally for clarity. The ASPECTS region most strongly associated with poor neurologic outcome was assigned a value of 1.0, and the remaining regions were assigned values relative to the maxima and according to their respective β-coefficients. Reprinted with permission from Barber et al.34 C indicates caudate nucleus; L, lentiform nucleus; IC, internal capsule; I, insula.

  • FIG 5.
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    FIG 5.

    Topography and outcome brain map generated using the β-coefficients from pooled ORs for each region based on DWI ASPECTS studies. Note that data shown are calculated from both hemispheres but are displayed unilaterally for clarity. The ASPECTS region most strongly associated with poor neurologic outcome was assigned a value of 1.0, and the remaining regions were assigned values relative to the maxima and according to their respective β-coefficients. Reprinted with permission from Barber et al.34 C indicates caudate nucleus; L, lentiform nucleus; IC, internal capsule; I, insula.

  • FIG 6.
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    FIG 6.

    Topography and outcome brain map generated using the β-coefficients from pooled ORs for each region based on the laterality of the stroke. The ASPECTS region most strongly associated with poor neurologic outcome was assigned a value of 1.0, and the remaining regions were assigned values relative to the maxima and according to their respective β-coefficients. Reprinted with permission from Barber et al.34 C indicates caudate nucleus; L, lentiform nucleus; IC, internal capsule; I, insula.

Tables

  • Figures
  • I2 Statistics and the Egger weighted regression statistics

    RegionI2I2 InterpretationEgger InterceptInterpretation
    M10.00%Low heterogeneity0.308 (P = .372)Publication bias not significant
    M219.56%Low heterogeneity0.532 (P = .309)Publication bias not significant
    M332.84%Moderate heterogeneity–0.026 (P = .491)Publication bias not significant
    M411.44%Low heterogeneity–0.207 (P = .414)Publication bias not significant
    M52.85%Low heterogeneity0.211 (P = .373)Publication bias not significant
    M618.21%Low heterogeneity–0.066 (P = .468)Publication bias not significant
    C17.36%Low heterogeneity–1.290 (P = .085)Publication bias not significant
    IC5.89%Low heterogeneity–1.372 (P = .031)Significant publication bias
    L14.91%Low heterogeneity–1.406 (P = .018)Significant publication bias
    I40.55%Moderate heterogeneity–1.670 (P = .023)Significant publication bias
    • Note:—C indicates caudate; IC, internal capsule; L, lentiform; I, insula.

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American Journal of Neuroradiology: 41 (11)
American Journal of Neuroradiology
Vol. 41, Issue 11
1 Nov 2020
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Cite this article
S.M. Seyedsaadat, A.A. Neuhaus, J.M. Pederson, W. Brinjikji, A.A. Rabinstein, D.F. Kallmes
Location-Specific ASPECTS Paradigm in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis
American Journal of Neuroradiology Nov 2020, 41 (11) 2020-2026; DOI: 10.3174/ajnr.A6847

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Location-Specific ASPECTS Paradigm in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis
S.M. Seyedsaadat, A.A. Neuhaus, J.M. Pederson, W. Brinjikji, A.A. Rabinstein, D.F. Kallmes
American Journal of Neuroradiology Nov 2020, 41 (11) 2020-2026; DOI: 10.3174/ajnr.A6847
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