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

Simon Nagel, Devesh Sinha, Diana Day, Wolfgang Reith, René Chapot, Panagiotis Papanagiotou, Elizabeth A. Warburton, Paul Guyler, Sharon Tysoe, Klaus Fassbender, Silke Walter, Marco Essig, Jens Heidenrich, Angelos A. Konstas, Michael Harrison, Michalis Papadakis, Eric Greveson, Olivier Joly, Stephen Gerry, Holly MaguireChristine Roffe, James Hampton-Till, Alastair M. Buchan, Iris Q. Grunwald

Research output: Contribution to journalArticlepeer-review

59 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)615-622
Number of pages8
JournalInternational Journal of Stroke
Volume12
Issue number6
Early online date1 Dec 2016
DOIs
Publication statusPublished - 1 Aug 2017

Keywords

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

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