title: e-ASPECTS software is non-inferior to neuroradiologists in applying the ASPECT score to computed tomography scans of acute ischemic stroke patients.
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.
authors.affiliation: 1 Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Nagel
authors.affiliation: 2 Department of Neuroradiology, Southend University Hospital NHS, Essex, UK.
authors.forename: Devesh
authors.initials: D
authors.lastname: Sinha
authors.affiliation: 3 Addenbrooke's Hospital NHS, Cambridge, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Day
authors.affiliation: 4 Department of Neuroradiology, Saarland University Hospital, Homburg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Reith
authors.affiliation: 5 Department of Neuroradiology, Alfred Krupp Krankenhaus, Essen, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Chapot
authors.affiliation: 6 Department of Neuroradiology, Bremen Hospital, Bremen, Germany.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Papanagiotou
authors.affiliation: 7 Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Warburton
authors.affiliation: 2 Department of Neuroradiology, Southend University Hospital NHS, Essex, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Guyler
authors.affiliation: 2 Department of Neuroradiology, Southend University Hospital NHS, Essex, UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Tysoe
authors.affiliation: 8 Department for Neurology, Saarland University Hospital, Homburg, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Fassbender
authors.affiliation: 8 Department for Neurology, Saarland University Hospital, Homburg, Germany.|9 Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Silke
authors.initials: S
authors.lastname: Walter
authors.affiliation: 10 Department of Radiology, University of Manitoba, Winnipeg, Canada.
authors.forename: Marco
authors.initials: M
authors.lastname: Essig
authors.affiliation: 11 Department of Diagnostic Radiology, Dalhousie University, Nova Scotia, Canada.
authors.forename: Jens
authors.initials: J
authors.lastname: Heidenrich
authors.affiliation: 12 Department of Radiology, Huntington Memorial Hospital, Pasadena, USA.
authors.forename: Angelos A
authors.initials: AA
authors.lastname: Konstas
authors.affiliation: 13 Clinical Trials Unit, Anglia Ruskin University, Essex, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Harrison
authors.affiliation: 14 Brainomix Limited, Oxford, UK.
authors.forename: Michalis
authors.initials: M
authors.lastname: Papadakis
authors.affiliation: 14 Brainomix Limited, Oxford, UK.
authors.forename: Eric
authors.initials: E
authors.lastname: Greveson
authors.affiliation: 14 Brainomix Limited, Oxford, UK.
authors.forename: Olivier
authors.initials: O
authors.lastname: Joly
authors.affiliation: 15 Centre for Statistics in Medicine, University of Oxford, Oxford, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Gerry
authors.affiliation: 16 Stroke Research, North Staffordshire Combined Healthcare NHS Trust, Staffordshire, UK.
authors.forename: Holly
authors.initials: H
authors.lastname: Maguire
authors.affiliation: 16 Stroke Research, North Staffordshire Combined Healthcare NHS Trust, Staffordshire, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Roffe
authors.affiliation: 13 Clinical Trials Unit, Anglia Ruskin University, Essex, UK.
authors.forename: James
authors.initials: J
authors.lastname: Hampton-Till
authors.affiliation: 9 Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Alastair M
authors.initials: AM
authors.lastname: Buchan
authors.affiliation: 2 Department of Neuroradiology, Southend University Hospital NHS, Essex, UK.|14 Brainomix Limited, Oxford, UK.|17 Neuroscience Department, Anglia Ruskin University, Essex, UK.
authors.forename: Iris Q
authors.initials: IQ
authors.lastname: Grunwald
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012984:Software; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy; D015899:Tomography, Emission-Computed, Single-Photon
keywords: Alberta Stroke Program Early Computed Tomography Score; computed tomography; ischemic stroke; machine learning