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European Radiology
Published in: European Radiology 11/2019

01-11-2019 | Stroke | Neuro

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

Authors: Friederike Austein, Fritz Wodarg, Nora Jürgensen, Monika Huhndorf, Johannes Meyne, Thomas Lindner, Olav Jansen, Naomi Larsen, Christian Riedel

Published in: European Radiology | Issue 11/2019

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Abstract

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.
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Metadata
Title
Automated versus manual imaging assessment of early ischemic changes in acute stroke: comparison of two software packages and expert consensus
Authors
Friederike Austein
Fritz Wodarg
Nora Jürgensen
Monika Huhndorf
Johannes Meyne
Thomas Lindner
Olav Jansen
Naomi Larsen
Christian Riedel
Publication date
01-11-2019
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06252-2

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