Alberta stroke program early CT score (ASPECTS)
The Alberta stroke programme early CT score (ASPECTS) 1 is a 10-point quantitative topographic CT scan score used in patients with middle cerebral artery (MCA) stroke. It has also been adapted for the posterior circulation (see below).
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Scoring system
Segmental assessment of the middle cerebral artery (MCA) vascular territory is made and 1 point is deducted from the initial score of 10 for every region involved:
- caudate
- putamen
- internal capsule
- insular cortex
- M1: "anterior MCA cortex," corresponding to frontal operculum
- M2: "MCA cortex lateral to insular ribbon" corresponding to anterior temporal lobe
- M3: "posterior MCA cortex" corresponding to posterior temporal lobe
- M4: "anterior MCA territory immediately superior to M1"
- M5: "lateral MCA territory immediately superior to M2"
- M6: "posterior MCA territory immediately superior to M3"
Important points
- the initial paper 1 specifically referred to the internal capsule only involving the posterior limb, however, subsequent articles indicate any portion of the internal capsule may be included
- M1 to M3 are at the level of the basal ganglia
- M4 to M6 is at the level of the ventricles immediately above the basal ganglia
Clinical use
An ASPECTS score less than or equal to 7 predicts a worse functional outcome at 3 months as well as symptomatic hemorrhage.
According to the study performed by R I Aviv et al., patients with ASPECTS score less than 8 treated with thrombolysis did not have a good clinical outcome 3.
Posterior circulation
Variations of the ASPECT scoring system have been described for use in the posterior circulation and referred to as pc-ASPECTS 5.
As is the case for the anterior circulation, the pc-ASPECTS is a 10 point scale, where points are lost for each region affected. Unlike ASPECTS, the pons and the midbrain are worth 2 points each (regardless of whether or not the changes are bilateral; any involvement of the pons, for example, deducted 2 points).
- thalami (1 point each)
- occipital lobes (1 point each)
- midbrain (2 points)
- pons (2 points)
- cerebellar hemispheres (1 point each)
Related Radiopaedia articles
Stroke and intracranial haemorrhage
-
stroke and intracranial hemorrhage
- code stroke CT (an approach)
-
ischemic stroke
- general discussions
- scoring and classification systems
- signs
- by region
- hemispheric infarcts
- frontal lobe infarct
- parietal lobe infarct
- temporal lobe infarct
- occipital lobe infarct
- alexia without agraphia syndrome: PCA
- cortical blindness syndrome (Anton syndrome): top of basilar or bilateral PCA
- Balint syndrome: bilateral PCA
- lacunar infarct
-
thalamic infarct
- Déjerine-Roussy syndrome (thalamic pain syndrome): thalamoperforators of PCA
- top of the basilar syndrome
- striatocapsular infarct
- cerebellar infarct
-
brainstem infarct
- midbrain infarct
- Benedikt syndrome: PCA
- Claude syndrome: PCA
- Nothnagel syndrome: PCA
- Weber syndrome: PCA
- pontine infarct
- Brissaud-Sicard syndrome
- facial colliculus syndrome
- Gasperini syndrome: basilar artery or AICA
- inferior medial pontine syndrome (Foville syndrome): basilar artery
- lateral pontine syndrome (Marie-Foix syndrome): basilar artery or AICA
- locked-in syndrome: basilar artery
- Millard-Gubler syndrome: basilar artery
- Raymond syndrome: basilar artery
- medullary infarct
- Babinski-Nageotte syndrome
- hemimedullary syndrome (Reinhold syndrome)
- lateral medullary stroke syndrome (Wallenberg syndrome)
- medial medullary syndrome (Déjerine syndrome)
- midbrain infarct
- acute spinal cord ischemia syndrome
- hemispheric infarcts
- by vascular territory
- treatment options
- complications
-
intracranial hemorrhage
-
intra-axial hemorrhage
- signs and formulas
- ABC/2 (volume estimation)
- CTA spot sign
- swirl sign
- by region or type
- signs and formulas
- extra-axial hemorrhage
-
intra-axial hemorrhage
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