Alberta stroke program early CT score (ASPECTS)

The Alberta stroke programme early CT score (ASPECTS) 1 is a 10-point quantitative topographic CT scan score used in patients with middle cerebral artery stroke. It has also been adapted for the posterior circulation (see below). 

Segmental assessment of the MCA vascular territory is made and 1 point is deducted from the initial score of 10 for every region involved:

  • caudate
  • putamen
  • internal capsule
  • insular cortex
  • M1: "anterior MCA cortex," corresponding to frontal operculum
  • M2: "MCA cortex lateral to insular ribbon" corresponding to anterior temporal lobe
  • M3: "posterior MCA cortex" corresponding to posterior temporal lobe
  • M4: "anterior MCA territory immediately superior to M1"
  • M5: "lateral MCA territory immediately superior to M2"
  • M6: "posterior MCA territory immediately superior to M3"
  1. the initial paper 1 specifically referred to the internal capsule only involving the posterior limb, however, subsequent articles indicate any portion of the internal capsule may be included
  2. M1 to M3 are at the level of the basal ganglia
  3. M4 to M6 is at the level of the ventricles immediately above the basal ganglia

An ASPECTS score less than or equal to 7 predicts a worse functional outcome at 3 months as well as symptomatic haemorrhage.

According to the study performed by R. I. Aviv et al., patients with ASPECTS score less than 8 treated with thrombolysis did not have a good clinical outcome 3.

Variations of the ASPECT scoring system have been described for use in the posterior circulation and referred to as pc-ASPECTS 5

As is the case for the anterior circulation, the pc-ASPECTS is a 10 point scale, where points are lost for each region affected. Unlike ASPECTS, the pons and the midbrain are worth 2 points each (regardless of whether or not the changes are bilateral; any involvement of the pons, for example, deducted 2 points).

  • thalami (1 point each)
  • occipital lobes (1 point each)
  • midbrain (2 points)
  • pons (2 points)
  • cerebellar hemispheres (1 point each) 
Share article

Article information

rID: 4936
Synonyms or Alternate Spellings:
  • Alberta stroke program early CT score (ASPECTS)
  • ASPECTS
  • pc-ASPECTS

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Figure 1
    Drag here to reorder.
  • Drag
    Figure 2
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.