From the Department of Diagnostic and Interventional Neuroradiology (C.M., J.F., S.M., M.B., M.L., T.B.B., C.Z., B.F.) and Department of Neurology (S.W., C.L.S.), Klinikum rechts der Isar, Technical University Munich, Ismaninger Str 22, 81675 Munich, Germany.
Radiology. 2019 Apr;291(1):141-148. doi: 10.1148/radiol.2019181228. Epub 2019 Feb 5.
Background The Alberta Stroke Program Early CT Score (ASPECTS) evaluation is a qualitative method to evaluate focal hypoattenuation at brain CT in early acute stroke. However, interobserver agreement is only moderate. Purpose To compare ASPECTS calculated by using an automatic software tool to neuroradiologist evaluation in the setting of acute stroke. Materials and Methods For this retrospective study, consensus ASPECTS were defined by two neuroradiologists based on baseline noncontrast CTs collected from January 2017 to December 2017 from patients with an occlusion in the middle cerebral artery and from an additional cohort of patients suspected of having stroke and no large vessel occlusion. Imaging data from both baseline and follow-up CT was evaluated for the consensus reading. After 6 weeks, the same two neuroradiologists again determined ASPECTS by using only the baseline CT. For comparison, ASPECTS was also calculated from baseline CT images by using a commercially available software (RAPID ASPECTS). Both methods were compared by using weighted κ statistics. Results CT scans from 100 patients with middle cerebral artery occlusion (44 women [mean age ± standard deviation, 75 years ± 14] and 56 men [mean age, 71 years ± 14]) and 52 patients suspected of having stroke and no large vessel occlusion (19 women [mean age, 69 years ± 18] and 33 men [68 years ± 15]) were evaluated. Neuroradiologists showed moderate agreement with the consensus score (κ = 0.57 and κ = 0.56). Software analysis showed substantial agreement (κ = 0.9) with the consensus score. Software analysis showed a substantial agreement (κ = 0.78) after greater than 1 hour between symptom onset and imaging, which increased to high agreement (κ = 0.92) in the time window greater than 4 hours. The neuroradiologist raters did not achieve comparable results to the software until the time interval of greater than 4 hours (κ = 0.83 and κ = 0.76). Conclusion In acute stroke of the middle cerebral artery, the Alberta Stroke Program Early CT score calculated with automated software had better agreement than that of human readers with a predefined consensus score. © RSNA, 2019 Online supplemental material is available for this article.
背景 阿尔伯塔省卒中计划早期 CT 评分（ASPECTS）评估是一种定性方法，用于评估急性卒中时脑 CT 上的局灶性低衰减。然而，观察者间的一致性仅为中等。目的 比较使用自动软件工具计算的 ASPECTS 与急性卒中患者的神经放射学家评估结果。材料与方法 本回顾性研究中，两位神经放射学家根据 2017 年 1 月至 2017 年 12 月期间大脑中动脉闭塞患者和另外一组疑似卒中且无大血管闭塞患者的基线非对比 CT ，定义了共识 ASPECTS。对基线和随访 CT 的影像学数据进行了共识阅读评估。6 周后，这两位神经放射学家再次仅使用基线 CT 确定 ASPECTS。为了比较，还使用商用软件（RAPID ASPECTS）从基线 CT 图像计算 ASPECTS。使用加权κ统计比较两种方法。结果 评估了 100 例大脑中动脉闭塞患者（44 例女性[平均年龄±标准差，75 岁±14]和 56 例男性[平均年龄，71 岁±14]）和 52 例疑似卒中且无大血管闭塞患者（19 例女性[平均年龄，69 岁±18]和 33 例男性[68 岁±15]）的 CT 扫描。神经放射学家与共识评分显示中度一致性（κ=0.57 和 κ=0.56）。软件分析与共识评分显示高度一致（κ=0.9）。发病后 1 小时以上，软件分析显示一致性较好（κ=0.78），4 小时以上时间窗内，一致性增加到高度一致（κ=0.92）。神经放射学家评分直到 4 小时以上的时间间隔才达到与软件相当的结果（κ=0.83 和 κ=0.76）。结论 在大脑中动脉急性卒中患者中，使用自动软件计算的 Alberta 卒中计划早期 CT 评分与预定义共识评分相比，具有更好的一致性。©RSNA，2019 在线补充材料可用于本文。
