Acute ischemic stroke — CT (ASPECTS)

CTASPECTS (Barber 2000)

Non-contrast CT in suspected acute anterior-circulation ischemic stroke.

Applies to

Suspected acute middle cerebral artery territory ischemic stroke on non-contrast CT

Does not apply to

Posterior circulation stroke (use pc-ASPECTS)
Established/old infarcts
Hemorrhage (assess separately first)

What to report

Tap an item to check it off while dictating.

1.Exclude hemorrhage
First confirm there is no intracranial hemorrhage before considering thrombolysis or thrombectomy.
2.ASPECTS regions
Assess the 10 MCA regions on two axial levels (ganglionic and supraganglionic) for hypoattenuation/loss of grey–white differentiation.
Pitfall: Score only regions with definite early ischemic change; a single equivocal region should not be over-called.
3.Hyperdense vessel sign
Look for a hyperdense MCA or 'dot' sign indicating intraluminal thrombus.
4.Insular ribbon and lentiform
Loss of the insular ribbon and obscuration of the lentiform nucleus are early, sensitive signs.
5.Vessel occlusion (CTA)
Correlate with CTA for a large-vessel occlusion and with CT perfusion for core/penumbra where available.
6.Time from onset
State the time from last-known-well, which drives treatment eligibility.

Sources

ASPECTS — Barber PA et al. Lancet (2000)

Content review: Content pending clinical review · 2026-07-10

Educational reference for trained clinicians. Verify every result against the cited original guideline before use. Not a substitute for clinical judgment or medical advice.

Acute ischemic stroke — CT (ASPECTS)

What to report

Scores & calculators

ASPECTS

Sources