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ASPECTS - Alberta Stroke Program Early CT Score

ASPECTS (Barber et al., 2000)

Scores early ischemic change in the ten MCA-territory regions on non-contrast CT; the score is 10 minus the number of abnormal regions.

Also searched as: MCA · ischemia · thrombectomy · brain · ct head

Interactive diagramClick the territories with early ischemic change — syncs with the region list below
RLRLM1M2M3CICLIM4M5M6basal ganglia levelsupraganglionic level
Affected hemisphere
Regions with early ischemic change (check all that apply)

Hypoattenuation, loss of gray-white differentiation, or focal swelling in a region subtracts 1 point.

Information
ASPECTS 10
Score: 10
  • No region marked abnormal; score assumes a CT without visible early ischemic change.
  • No region shows visible early ischemic change.
Caveats
  • ASPECTS <=7: associated with worse functional outcome and less thrombolysis benefit in the original Barber et al. validation.
  • Interpret together with CTA/vessel status, clinical deficit, treatment window, and, where available, perfusion imaging; subtle hypoattenuation is easier to appreciate with narrow window settings.
  • Posterior-circulation strokes are not captured by MCA ASPECTS (a separate pc-ASPECTS exists).

How this tool works

ASPECTS divides the middle cerebral artery territory into ten regions - caudate head, lentiform nucleus, internal capsule, insular cortex, and six cortical zones (M1-M3 at the ganglionic level, M4-M6 at the supraganglionic level). Each region showing parenchymal hypoattenuation, loss of gray-white differentiation, or focal swelling subtracts one point from a baseline of 10. Lower scores indicate a larger established infarct core: scores of 7 or below were associated with dependence or death and reduced benefit from thrombolysis in the original validation, scores of 6 or more were typical inclusion criteria in early thrombectomy trials, and scores of 3-5 define much of the large-core population studied in more recent trials. The score standardizes communication and is always interpreted with vessel imaging, clinical severity, and time from onset.

References

Implemented from the cited published sources. Educational use only; confirm against current guidelines before clinical use.

Clinical questions that use this

Vetting guides that reach for this tool.

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