Automated Calculation of Alberta Stroke Program Early CT Score

Author:

Albers Gregory W.1,Wald Michael J.2,Mlynash Michael1,Endres Juergen3,Bammer Roland4,Straka Matus3,Maier Andreas5,Hinson Holly E.6,Sheth Kevin N.7,Taylor Kimberly W.8,Molyneaux Bradley J.9

Affiliation:

1. From the Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, CA (G.W.A., M.M.)

2. Biogen, Inc, Cambridge, MA (M.J.W.)

3. iSchemaView, Inc, Menlo Park, CA (J.E., M.S.)

4. Department of Radiology, University of Melbourne, Victoria, Australia (R.B.)

5. Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg (A.M.)

6. Department of Neurology, Oregon Health Sciences University (H.E.H.)

7. Division of Neurocritical Care and Emergency, Yale University, New Haven, CT (K.N.S.)

8. Department of Neurology and Center for Genomic Medicine, Massachusetts General Hospital (W.T.K.)

9. Department of Neurology, University of Pittsburgh, PA (B.J.M.).

Abstract

Background and Purpose— We compared the Alberta Stroke Program Early CT Score (ASPECTS), calculated using a machine learning-based automatic software tool, RAPID ASPECTS, as well as the median score from 4 experienced readers, with the diffusion-weighted imaging (DWI) ASPECTS obtained following the baseline computed tomography (CT) in patients with large hemispheric infarcts. Methods— CT and magnetic resonance imaging scans from the GAMES-RP study, which enrolled patients with large hemispheric infarctions (82–300 mL) documented on DWI-magnetic resonance imaging, were evaluated by blinded experienced readers to determine both CT and DWI ASPECTS. The CT scans were also evaluated by an automated software program (RAPID ASPECTS). Using the DWI ASPECTS as a reference standard, the median CT ASPECTS of the clinicians and the automated score were compared using the interclass correlation coefficient. Results— The median CT ASPECTS for the clinicians was 5 (interquartile range, 4–7), for RAPID ASPECTS 3 (interquartile range, 1–6), and for DWI ASPECTS 3 (2–4). Median error for RAPID ASPECTS was 1 (interquartile range, −1 to 3) versus 3 (interquartile range, 1–4) for clinicians ( P <0.001). The automated score had a higher level of agreement with the median of the DWI ASPECTS, both for the full scale and when dichotomized at <6 versus 6 or more (difference in intraclass correlation coefficient, P =0.001). Conclusions— RAPID ASPECTS was more accurate than experienced clinicians in identifying early evidence of brain ischemia as documented by DWI.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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