Introduction. Ischemic stroke incidence and mortality rates show a constantly increasing trend worldwide. As the only speci fic treatment for ischemic stroke, considered the gold standard, tissue plasminogen activator can be applied only in first 3 hours from the symptoms onset, imaging report must contain maximal volume of information regarding the ischemic lesion. The Alberta Stroke Program Early Computer Tomography Score ( accurately classifies and standardizes regions of middle cerebral artery circulations and describes the subtle changes in imaging patterns, providing possibility to identify ischemia and appreciate its severity. ASPECTS represents a quantitative topographic assessment scale with 10 points for normal brain appearance and subtraction of 1 point for every area, where early ischemic signs are present. Aim of the study. To appreciate applicability of ASPE CTS reporting in CT studies in the routine workflow for identification and severity assessment of acute ischemic stroke. Materials and methods. Our prospective study has included the evaluation of 167 consecutive patients with acute middle cerebral artery ( ischemic stroke (first 6 hours) with ASPECTS score reporting for admission non contrast CT ( functional perfusion CT ( maps (48 patients). Volume and severity of final ischemic injury was assessed in ASPECTS circulation zones on the control non contrast CT scan in subacute phase. Results. Of total 1670 NCCT ASPECTS regions (10 zones in 167 patients), 542 regions showed final stroke on control NCCT scan. Sensitivity and overall accuracy of NCCT ASPECTS score, comparatively to the subacute NCC T scan, consisted 43% and 80% respectively. Of total 480 PCT cerebral blood volume regions, 155 showed final ischemic lesion on control NCCT. Sensitivity and overall accuracy of PCT ASPECTS score, comparatively to the subacute NCCT scan, consisted 89% and 93% respectively. Conclusions. ASPECTS imaging grading model represents important, fast, reliable reporting score in patients with acute MCA ischemic stroke and shows greater accuracy in PCT maps. Introducing of ASPECTS reporting system increase substantially inter reader agreement and rapidity of assessment and inter disciplinary medical communication, regarding the ischemic brain patterns not only in hyperacute phase, but also in final stroke lesion in subacute phase. Application of ASPECTS zones classification in routine reports prov ides essential information for stroke assessment and emergency decision making.