Automated versus manual imaging assessment of early ischemic changes in acute stroke: comparison of two software packages and expert consensus
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The purpose of our study was to compare the agreement of both the total Alberta Stroke Program Early CT Score (ASPECTS) and region-based scores from two automated ASPECTS software packages and an expert consensus (EC) reading with final ASPECTS in a selected cohort of patients who had prompt reperfusion from endovascular thrombectomy (EVT).
ASPECTS were retrospectively and blindly assessed by two software packages and EC on baseline non-contrast-enhanced computed tomography (NCCT) images. All patients had multimodal CT imaging including NCCT, CT angiography, and CT perfusion which demonstrated an acute anterior circulation ischemic stroke with a large vessel occlusion. Final ASPECTS on follow-up scans in patients who had EVT and achieved complete reperfusion within 100 min from NCCT served as ground truth and were compared to total and region-based scores.
Fifty-two patients met our study criteria. Moderate agreement was obtained between both software packages and EC for total ASPECTS and there was no significant difference in overall performance. However, the software packages differed with respect to regional contribution. In this cohort, the majority of infarcted regions were deep structures. Package A was more sensitive in cortical areas than the other methods, but at a cost of specificity. EC and software package B had greater sensitivity, but lower specificity for deep brain structures.
In this cohort, using the final ASPECTS as ground truth, no clinically significant difference was observed for total ASPECT score between human or automated packages, but there were differences in the characteristics of the regions scored.
• Some national stroke guidelines have incorporated ASPECTS in their recommendations for selecting patients for endovascular therapy.
• Computer-aided diagnosis is a promising tool to aid the evaluation of early ischemic changes identified on CT.
• Software packages for automated ASPECTS assessment differed significantly with respect to regional contribution without any significant difference in the overall ASPECT score.
KeywordsImage interpretation Computer assisted Software validation Stroke Thrombectomy
Alberta Stroke Program Early CT Score
Early ischemic changes
Non-contrast computed tomography
Receiver operating characteristic
- TICI 3
Thrombolysis in cerebral infarction with complete reperfusion
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Olav Jansen.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
One of the authors has significant statistical expertise.
No complex statistical methods were necessary for this paper.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• Diagnostic study or prognostic study
• Performed at one institution
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