Collateral Automation for Triage in Stroke: Evaluating Automated Scoring of Collaterals in Acute Stroke on Computed Tomography Scans

TY - JOUR

T1 - Collateral Automation for Triage in Stroke

T2 - Evaluating Automated Scoring of Collaterals in Acute Stroke on Computed Tomography Scans

AU - Grunwald, Iris Q.

AU - Kulikovski, Johann

AU - Reith, Wolfgang

AU - Gerry, Stephen

AU - Namias, Rafael

AU - Politi, Maria

AU - Papanagiotou, Panagiotis

AU - Essig, Marco

AU - Mathur, Shrey

AU - Joly, Olivier

AU - Hussain, Khawar

AU - Wagner, Viola

AU - Shah, Sweni

AU - Harston, George

AU - Vlahovic, Julija

AU - Walter, Silke

AU - Podlasek, Anna

AU - Fassbender, Klaus

N1 - Copyright: © 2019 The Author(s). Published by S. Karger AG, Basel.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Computed tomography angiography (CTA) collateral scoring can identify patients most likely to benefit from mechanical thrombectomy and those more likely to have good outcomes and ranges from 0 (no collaterals) to 3 (complete collaterals). In this study, we used a machine learning approach to categorise the degree of collateral flow in 98 patients who were eligible for mechanical thrombectomy and generate an e-CTA collateral score (CTA-CS) for each patient (e-STROKE SUITE, Brainomix Ltd., Oxford, UK). Three experienced neuroradiologists (NRs) independently estimated the CTA-CS, first without and then with knowledge of the e-CTA output, before finally agreeing on a consensus score. Addition of the e-CTA improved the intraclass correlation coefficient (ICC) between NRs from 0.58 (0.46-0.67) to 0.77 (0.66-0.85, p = 0.003). Automated e-CTA, without NR input, agreed with the consensus score in 90% of scans with the remaining 10% within 1 point of the consensus (ICC 0.93, 0.90-0.95). Sensitivity and specificity for identifying favourable collateral flow (collateral score 2-3) were 0.99 (0.93-1.00) and 0.94 (0.70-1.00), respectively. e-CTA correlated with the Alberta Stroke Programme Early CT Score (Spearman correlation 0.46, p < 0.001) highlighting the value of good collateral flow in maintaining tissue viability prior to reperfusion. In conclusion, -e-CTA provides a real-time and fully automated approach to collateral scoring with the potential to improve consistency of image interpretation and to independently quantify collateral scores even without expert rater input.

AB - Computed tomography angiography (CTA) collateral scoring can identify patients most likely to benefit from mechanical thrombectomy and those more likely to have good outcomes and ranges from 0 (no collaterals) to 3 (complete collaterals). In this study, we used a machine learning approach to categorise the degree of collateral flow in 98 patients who were eligible for mechanical thrombectomy and generate an e-CTA collateral score (CTA-CS) for each patient (e-STROKE SUITE, Brainomix Ltd., Oxford, UK). Three experienced neuroradiologists (NRs) independently estimated the CTA-CS, first without and then with knowledge of the e-CTA output, before finally agreeing on a consensus score. Addition of the e-CTA improved the intraclass correlation coefficient (ICC) between NRs from 0.58 (0.46-0.67) to 0.77 (0.66-0.85, p = 0.003). Automated e-CTA, without NR input, agreed with the consensus score in 90% of scans with the remaining 10% within 1 point of the consensus (ICC 0.93, 0.90-0.95). Sensitivity and specificity for identifying favourable collateral flow (collateral score 2-3) were 0.99 (0.93-1.00) and 0.94 (0.70-1.00), respectively. e-CTA correlated with the Alberta Stroke Programme Early CT Score (Spearman correlation 0.46, p < 0.001) highlighting the value of good collateral flow in maintaining tissue viability prior to reperfusion. In conclusion, -e-CTA provides a real-time and fully automated approach to collateral scoring with the potential to improve consistency of image interpretation and to independently quantify collateral scores even without expert rater input.

KW - Acute stroke

KW - Alberta stroke programme early CT score

KW - Collateral circulation

KW - Computed tomography angiography

KW - e-Alberta stroke programme early CT score

KW - e-Computed tomography angiography

KW - Thrombectomy

UR - https://www.scopus.com/pages/publications/85067892984

U2 - 10.1159/000500076

DO - 10.1159/000500076

M3 - Article

C2 - 31216543

AN - SCOPUS:85067892984

SN - 1015-9770

VL - 47

SP - 217

EP - 222

JO - Cerebrovascular Diseases

JF - Cerebrovascular Diseases

IS - 5-6

ER -