Automated versus manual imaging assessment of early ischemic changes in acute stroke: comparison of two software packages and expert consensus

TY - JOUR

T1 - Automated versus manual imaging assessment of early ischemic changes in acute stroke: comparison of two software packages and expert consensus

AU - Austein, Friederike

AU - Wodarg, Fritz

AU - Jürgensen, Nora

AU - Huhndorf, Monika

AU - Meyne, Johannes

AU - Lindner, Thomas

AU - Jansen, Olav

AU - Larsen, Naomi

AU - Riedel, Christian

PY - 2019/11

Y1 - 2019/11

N2 - AIM: The purpose of our study was to compare the agreement of both the total Alberta Stroke Program Early CT Score (ASPECTS) and region-based scores from two automated ASPECTS software packages and an expert consensus (EC) reading with final ASPECTS in a selected cohort of patients who had prompt reperfusion from endovascular thrombectomy (EVT).METHODS: ASPECTS were retrospectively and blindly assessed by two software packages and EC on baseline non-contrast-enhanced computed tomography (NCCT) images. All patients had multimodal CT imaging including NCCT, CT angiography, and CT perfusion which demonstrated an acute anterior circulation ischemic stroke with a large vessel occlusion. Final ASPECTS on follow-up scans in patients who had EVT and achieved complete reperfusion within 100 min from NCCT served as ground truth and were compared to total and region-based scores.RESULTS: Fifty-two patients met our study criteria. Moderate agreement was obtained between both software packages and EC for total ASPECTS and there was no significant difference in overall performance. However, the software packages differed with respect to regional contribution. In this cohort, the majority of infarcted regions were deep structures. Package A was more sensitive in cortical areas than the other methods, but at a cost of specificity. EC and software package B had greater sensitivity, but lower specificity for deep brain structures.CONCLUSION: In this cohort, using the final ASPECTS as ground truth, no clinically significant difference was observed for total ASPECT score between human or automated packages, but there were differences in the characteristics of the regions scored.KEY POINTS: • Some national stroke guidelines have incorporated ASPECTS in their recommendations for selecting patients for endovascular therapy. • Computer-aided diagnosis is a promising tool to aid the evaluation of early ischemic changes identified on CT. • Software packages for automated ASPECTS assessment differed significantly with respect to regional contribution without any significant difference in the overall ASPECT score.

AB - AIM: The purpose of our study was to compare the agreement of both the total Alberta Stroke Program Early CT Score (ASPECTS) and region-based scores from two automated ASPECTS software packages and an expert consensus (EC) reading with final ASPECTS in a selected cohort of patients who had prompt reperfusion from endovascular thrombectomy (EVT).METHODS: ASPECTS were retrospectively and blindly assessed by two software packages and EC on baseline non-contrast-enhanced computed tomography (NCCT) images. All patients had multimodal CT imaging including NCCT, CT angiography, and CT perfusion which demonstrated an acute anterior circulation ischemic stroke with a large vessel occlusion. Final ASPECTS on follow-up scans in patients who had EVT and achieved complete reperfusion within 100 min from NCCT served as ground truth and were compared to total and region-based scores.RESULTS: Fifty-two patients met our study criteria. Moderate agreement was obtained between both software packages and EC for total ASPECTS and there was no significant difference in overall performance. However, the software packages differed with respect to regional contribution. In this cohort, the majority of infarcted regions were deep structures. Package A was more sensitive in cortical areas than the other methods, but at a cost of specificity. EC and software package B had greater sensitivity, but lower specificity for deep brain structures.CONCLUSION: In this cohort, using the final ASPECTS as ground truth, no clinically significant difference was observed for total ASPECT score between human or automated packages, but there were differences in the characteristics of the regions scored.KEY POINTS: • Some national stroke guidelines have incorporated ASPECTS in their recommendations for selecting patients for endovascular therapy. • Computer-aided diagnosis is a promising tool to aid the evaluation of early ischemic changes identified on CT. • Software packages for automated ASPECTS assessment differed significantly with respect to regional contribution without any significant difference in the overall ASPECT score.

KW - Aged

KW - Aged, 80 and over

KW - Attitude of Health Personnel

KW - Brain Ischemia/diagnostic imaging

KW - Cohort Studies

KW - Computed Tomography Angiography/methods

KW - Diagnosis, Computer-Assisted/methods

KW - Expert Testimony

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Multimodal Imaging

KW - Reperfusion

KW - Retrospective Studies

KW - Sensitivity and Specificity

KW - Software/standards

KW - Stroke/diagnostic imaging

KW - Thrombectomy/methods

KW - Tomography, X-Ray Computed/methods

U2 - 10.1007/s00330-019-06252-2

DO - 10.1007/s00330-019-06252-2

M3 - SCORING: Journal article

C2 - 31076862

VL - 29

SP - 6285

EP - 6292

JO - EUR RADIOL

JF - EUR RADIOL

SN - 0938-7994

IS - 11

ER -