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Posterior Circulation ASPECTS (pc-ASPECTS)

pc-ASPECTS (Puetz 2008)

A 10-point CT scoring system for early ischemic change in the posterior circulation. Points are deducted for hypoattenuation in the thalami, cerebellum and occipital lobes (1 each side) and in the midbrain and pons (2 each); 10 means no visible ischemia.

Also searched as: stroke · basilar · brainstem

Interactive diagramClick the affected regions — midbrain and pons count 2 points each
RLRLoccoccththmidbraincerebellumcerebellumponsmidbrain / thalamus levelpons / cerebellum level
Regions with early ischemic change

Select every region showing hypoattenuation (CT/CTA source images) or restricted diffusion. Leave empty for a normal study.

Information
pc-ASPECTS = 10
Score: 10
  • No early ischemic change in any scored posterior-circulation region.
  • The score starts at 10; 1 point is subtracted for each involved thalamus, cerebellar hemisphere or occipital/PCA territory (per side), and 2 points each for midbrain and pons involvement.
Caveats
  • Unlike anterior-circulation ASPECTS, no single pc-ASPECTS treatment cutoff is universally accepted; report the score descriptively alongside vessel status and clinical severity.
  • Originally validated on CT angiography source images (Puetz 2008); the same region weights are commonly applied to non-contrast CT and DWI.

How this tool works

pc-ASPECTS adapts the Alberta Stroke Program Early CT Score concept to the vertebrobasilar territory. Beginning from 10, one point is subtracted for early ischemic change in each thalamus, each cerebellar hemisphere and each occipital (posterior cerebral artery) territory, and two points each for the midbrain and pons, reflecting the graver consequence of brainstem infarction. It was developed and validated on CT angiography source images in basilar artery occlusion (Puetz 2008) and is also applied to non-contrast CT and diffusion MRI. Lower scores denote a larger ischemic burden and correlate with poorer functional outcome; no single treatment threshold is universally accepted.

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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