Automated ASPECTS for multi-modality CT predict infarct extent and outcome in large-vessel occlusion stroke

•CTA-venous-ASPECTS is a reliable tool to predict the infarct extent and outcome.•CTA-venous-ASPECTS facilitates treatment decisions after large vessel occlusion.•Best sensitivity of mismatch-ASPECTS to predict good outcomes after treatment. This study aimed to use the automated Alberta Stroke Program Early CT Score (ASPECTS) software to assess the value of different CT modalities (non-contrast CT, CT angiography [CTA]-arterial, CTA-venous, and arterial- and venous-phase mismatch-ASPECTS) in predicting the final infarct extent and clinical outcome in large-vessel occlusion stroke. This retrospective study included patients with large-vessel occlusion stroke who underwent reperfusion therapy during 2015 to 2019. Correlations between different CT-ASPECTS modalities and follow-up CT-ASPECTS and outcome were determined using Spearman rank correlation coefficient. Receiver operating characteristic curve analysis was used to assess the ability of different CT-ASPECTS modalities to identify patients with good outcomes. One hundred and thirty-five patients were included. We found almost-perfect correlation between CTA-venous-ASPECTS and follow-up CT-ASPECTS (r = 0.92; 95% CI: 0.89–0.95), better than that in other CT modalities. The 90-day modified Rankin scale (mRS) score substantially correlated with CTA-venous-ASPECTS (r = -0.64; 95% CI: −0.73 to −0.52). The ROC curve analysis showed CTA-venous-ASPECTS had the highest area under the curve (AUC: 0.82; 95% CI: 0.75–0.89; P