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Published in: Clinical Neuroradiology 4/2021

Open Access 01-12-2021 | Computed Tomography | Original Article

ASPECTS Interobserver Agreement of 100 Investigators from the TENSION Study

Authors: Noel van Horn, Helge Kniep, Gabriel Broocks, Lukas Meyer, Fabian Flottmann, Matthias Bechstein, Julia Götz, Götz Thomalla, Martin Bendszus, Susanne Bonekamp, Johannes Alex Rolf Pfaff, Paulo Roberto Dellani, Jens Fiehler, Uta Hanning

Published in: Clinical Neuroradiology | Issue 4/2021

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Abstract

Purpose

Evaluating the extent of cerebral ischemic infarction is essential for treatment decisions and assessment of possible complications in patients with acute ischemic stroke. Patients are often triaged according to image-based early signs of infarction, defined by Alberta Stroke Program Early CT Score (ASPECTS). Our aim was to evaluate interrater reliability in a large group of readers.

Methods

We retrospectively analyzed 100 investigators who independently evaluated 20 non-contrast computed tomography (NCCT) scans as part of their qualification program for the TENSION study. Test cases were chosen by four neuroradiologists who had previously scored NCCT scans with ASPECTS between 0 and 8 and high interrater agreement. Percent and interrater agreements were calculated for total ASPECTS, as well as for each ASPECTS region.

Results

Percent agreements for ASPECTS ratings was 28%, with interrater agreement of 0.13 (95% confidence interval, CI 0.09–0.16), at zero tolerance allowance and 66%, with interrater agreement of 0.32 (95% CI: 0.21–0.44), at tolerance allowance set by TENSION inclusion criteria. ASPECTS region with highest level of agreement was the insular cortex (percent agreement = 96%, interrater agreement = 0.96 (95% CI: 0.94–0.97)) and with lowest level of agreement the M3 region (percent agreement = 68%, interrater agreement = 0.39 [95% CI: 0.17–0.61]).

Conclusion

Interrater agreement reliability for total ASPECTS and study enrollment was relatively low but seems sufficient for practical application. Individual region analysis suggests that some are particularly difficult to evaluate, with varying levels of reliability. Potential impairment of the supraganglionic region must be examined carefully, particularly with respect to the decision whether or not to perform mechanical thrombectomy.
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Metadata
Title
ASPECTS Interobserver Agreement of 100 Investigators from the TENSION Study
Authors
Noel van Horn
Helge Kniep
Gabriel Broocks
Lukas Meyer
Fabian Flottmann
Matthias Bechstein
Julia Götz
Götz Thomalla
Martin Bendszus
Susanne Bonekamp
Johannes Alex Rolf Pfaff
Paulo Roberto Dellani
Jens Fiehler
Uta Hanning
Publication date
01-12-2021
Publisher
Springer Berlin Heidelberg
Published in
Clinical Neuroradiology / Issue 4/2021
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-020-00988-x

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