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. 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

Simon Nagel  1 , Devesh Sinha  2 , Diana Day  3 , Wolfgang Reith  4 , René Chapot  5 , Panagiotis Papanagiotou  6 , Elizabeth A Warburton  7 , Paul Guyler  2 , Sharon Tysoe  2 , Klaus Fassbender  8 , Silke Walter  8   9 , Marco Essig  10 , Jens Heidenrich  11 , Angelos A Konstas  12 , Michael Harrison  13 , Michalis Papadakis  14 , Eric Greveson  14 , Olivier Joly  14 , Stephen Gerry  15 , Holly Maguire  16 , Christine Roffe  16 , James Hampton-Till  13 , Alastair M Buchan  9 , Iris Q Grunwald  2   14   17
Affiliations

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

Simon Nagel et al. Int J Stroke. 2017 Aug.

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.

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