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Int J Stroke. 2017 Aug;12(6):615-622. doi: 10.1177/1747493016681020. Epub 2016 Dec 1.

e-ASPECTS software is non-inferior to neuroradiologists in applying the ASPECT score to computed tomography scans of acute ischemic stroke patients.

Author information

1
1 Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
2
2 Department of Neuroradiology, Southend University Hospital NHS, Essex, UK.
3
3 Addenbrooke's Hospital NHS, Cambridge, UK.
4
4 Department of Neuroradiology, Saarland University Hospital, Homburg, Germany.
5
5 Department of Neuroradiology, Alfred Krupp Krankenhaus, Essen, Germany.
6
6 Department of Neuroradiology, Bremen Hospital, Bremen, Germany.
7
7 Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
8
8 Department for Neurology, Saarland University Hospital, Homburg, Germany.
9
9 Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
10
10 Department of Radiology, University of Manitoba, Winnipeg, Canada.
11
11 Department of Diagnostic Radiology, Dalhousie University, Nova Scotia, Canada.
12
12 Department of Radiology, Huntington Memorial Hospital, Pasadena, USA.
13
13 Clinical Trials Unit, Anglia Ruskin University, Essex, UK.
14
14 Brainomix Limited, Oxford, UK.
15
15 Centre for Statistics in Medicine, University of Oxford, Oxford, UK.
16
16 Stroke Research, North Staffordshire Combined Healthcare NHS Trust, Staffordshire, UK.
17
17 Neuroscience Department, Anglia Ruskin University, Essex, UK.

Abstract

Background The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is an established 10-point quantitative topographic computed tomography scan score to assess early ischemic changes. We performed a non-inferiority trial between the e-ASPECTS software and neuroradiologists in scoring ASPECTS on non-contrast enhanced computed tomography images of acute ischemic stroke patients. Methods In this multicenter study, e-ASPECTS and three independent neuroradiologists retrospectively and blindly assessed baseline non-contrast enhanced computed tomography images of 132 patients with acute anterior circulation ischemic stroke. Follow-up scans served as ground truth to determine the definite area of infarction. Sensitivity, specificity, and accuracy for region- and score-based analysis, receiver-operating characteristic curves, Bland-Altman plots and Matthews correlation coefficients relative to the ground truth were calculated and comparisons were made between neuroradiologists and different pre-specified e-ASPECTS operating points. The non-inferiority margin was set to 10% for both sensitivity and specificity on region-based analysis. Results In total 2640 (132 patients × 20 regions per patient) ASPECTS regions were scored. Mean time from onset to baseline computed tomography was 146 ± 124 min and median NIH Stroke Scale (NIHSS) was 11 (6-17, interquartile range). Median ASPECTS for ground truth on follow-up imaging was 8 (6.5-9, interquartile range). In the region-based analysis, two e-ASPECTS operating points (sensitivity, specificity, and accuracy of 44%, 93%, 87% and 44%, 91%, 85%) were statistically non-inferior to all three neuroradiologists (all p-values <0.003). Both Matthews correlation coefficients for e-ASPECTS were higher (0.36 and 0.34) than those of all neuroradiologists (0.32, 0.31, and 0.3). Conclusions e-ASPECTS was non-inferior to three neuroradiologists in scoring ASPECTS on non-contrast enhanced computed tomography images of acute stroke patients.

KEYWORDS:

Alberta Stroke Program Early Computed Tomography Score; computed tomography; ischemic stroke; machine learning

PMID:
27899743
DOI:
10.1177/1747493016681020
[Indexed for MEDLINE]

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