Accuracy of Alberta stroke program early computed tomography score (aspects) as a predictor of outcomes in acute ischemic stroke patients.

Abstract

Objective: To evaluate the diagnostic accuracy of ASPECTS in determining the outcomes (good versus poor) among AIS patients by taking Modified Rankin Score (MRS) as gold standard. Study Design: Validation study. Setting: Department of Radiology, Shifa International Hospital, Islamabad. Period: July 2025 to November 2025. Methods: A total of 646 patients aged 18–65 years with middle cerebral artery territory acute ischemic stroke who underwent NCCT within two days of symptom onset were included using consecutive sampling. ASPECTS was calculated on NCCT and categorized as good (8–10) or poor (0–7). Functional outcome was assessed at discharge using the modified Rankin Scale, classified as good (0–3) or poor (4–6). DA parameters including sensitivity, specificity, PPV, NPV, and receiver operating characteristic (ROC) curve analysis were calculated using SPSS version 25. Results: Out of 646 patients, 53.3% had good ASPECTS scores, while 63.3% achieved good functional outcomes. Using an ASPECTS cutoff of ≥8, sensitivity was 73.1%, specificity 81.0%, PPV 86.9%, and NPV 63.6%. The overall diagnostic accuracy was 76.0%. The area under the ROC curve was 0.79, indicating good discriminative ability of ASPECTS in predicting functional outcomes. Conclusion: ASPECTS is a reliable and clinically useful imaging tool for early prediction of functional outcomes in acute ischemic stroke. Its good diagnostic accuracy, ease of application, and reliance on widely available NCCT make it particularly valuable for early stroke assessment, especially in resource-limited settings.