ToolsCalculators
Alberta Stroke Program Early CT Score (ASPECTS)
Quantifies early ischemic change on non-contrast CT in MCA-territory stroke.
Alberta Stroke Program Early CT Score (ASPECTS)
Caudate – early ischemic change present
Lentiform nucleus – early ischemic change present
Internal capsule – early ischemic change present
Insular ribbon – early ischemic change present
M1 – anterior MCA cortex – early ischemic change present
M2 – MCA cortex lateral to insular ribbon – early ischemic change present
M3 – posterior MCA cortex – early ischemic change present
M4 – anterior MCA territory, superior to M1 – early ischemic change present
M5 – lateral MCA territory, superior to M2 – early ischemic change present
M6 – posterior MCA territory, superior to M3 – early ischemic change present
Result10 points
Limited early ischemic change; CT appearance not a contraindication to reperfusion therapy on ASPECTS grounds alone.
- Regions with early ischemic change
- 0
When to use
- Grading the extent of early ischemic change on non-contrast CT in acute anterior-circulation (MCA-territory) ischemic stroke.
- Supporting patient selection for IV thrombolysis or mechanical thrombectomy alongside clinical and other imaging criteria.
Formula
ASPECTS = 10 minus the number of the 10 defined MCA regions (caudate, lentiform nucleus, internal capsule, insular ribbon, and cortical regions M1-M6) that show early ischemic change on non-contrast CT. Score ranges from 10 (no early ischemic change) to 0 (diffuse involvement of the entire MCA territory).
Pearls and pitfalls
- Best read on the two standardized axial CT levels: the ganglionic level (caudate, lentiform, internal capsule, insula, M1-M3) and the supraganglionic level (M4-M6).
- A subcortical region (caudate, lentiform, internal capsule) counts as involved even with subtle hypoattenuation or loss of grey-white differentiation.