E-ASPECTS software is non-inferior to neuroradiologists in applying the ASPECT score to computed tomography scans of acute ischemic stroke patients. Issue 6 (August 2017)

• Record Type: Journal Article
• Authors: Nagel, Simon; Sinha, Devesh; Day, Diana; Reith, Wolfgang; Chapot, René; Papanagiotou, Panagiotis; Warburton, Elizabeth A; Guyler, Paul; Tysoe, Sharon; Fassbender, Klaus; Walter, Silke; Essig, Marco; Heidenrich, Jens; Konstas, Angelos A; Harrison, Michael; Papadakis, Michalis; Greveson, Eric; Joly, Olivier; Gerry, Stephen; Maguire, Holly; Roffe, Christine; Hampton-Till, James; Buchan, Alastair M; Grunwald, Iris Q
• Is Part Of: International journal of stroke. Volume 12:Issue 6(2017)
• Page Start: 615
• Page End: 622
• Publication Date: 2017-08
• Subjects: Alberta Stroke Program Early Computed Tomography Score -- computed tomography -- ischemic stroke -- machine learning; 616.8005
• DOI: 10.1177/1747493016681020
• Languages: English
• ISSNs: 1747-4930

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.