Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California.
Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California.
J Stroke Cerebrovasc Dis. 2020 Jul;29(7):104820. doi: 10.1016/j.jstrokecerebrovasdis.2020.104820. Epub 2020 Apr 16.
The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is widely used to quantify early ischemic changes in the anterior circulation but has limited inter-rater reliability.
We investigated whether application of 3-dimensional boundaries outlining the ASPECTS regions improves inter-rater reliability and accuracy.
We included all patients from our DEFUSE 2 database who had a pretreatment noncontrast computed tomography scan (NCCT) of acceptable quality. Six raters (2 neuroradiologists, 2 vascular neurologists, and 2 neurology residents) scored ASPECTS of each NCCT without ("CT-native") and with the superimposed boundary template ("CT-template"). Gold-standard ASPECTS were generated by the 2 neuroradiologists through joint adjudication. Inter-rater reliability and accuracy were assessed using the intraclass correlation coefficient (ICC) for full-scale agreements and Gwet's AC1 for dichotomized (ASPECTS 0-6 vs 7-10) agreements.
Eighty-two patients were included. Inter-rater reliability improved with higher training level for both CT-native (ICC = .15, .31, .54 for residents, neurologists, and radiologists, respectively) and CT-template (ICC = .18, .33, .56). Use of the boundary template improved correlation with the gold-standard for one resident on full-scale agreement (ICC increased from .01 to .31, P = .01) and another resident on dichotomized agreement (AC1 increased from .36 to .64, P = .01), but resulted in no difference for other raters. The template did not improve ICC between raters of the same training level.
Inter-rater reliability of ASPECTS improves with physician training level. Standardized display of ASPECTS region boundaries on NCCT does not improve inter-rater reliability but may improve accuracy for some less experienced raters.
阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）广泛用于量化前循环中的早期缺血性改变，但信度有限。
我们研究了是否应用 3 维边界勾画 ASPECTS 区域可以提高信度和准确性。
我们纳入了所有来自 DEFUSE 2 数据库的患者，这些患者均有质量可接受的治疗前非对比计算机断层扫描（NCCT）。6 名评估者（2 名神经放射科医师、2 名血管神经病学家和 2 名神经科住院医师）对每个 NCCT 进行了 ASPECTS 评分，既有无叠加边界模板（CT-native）的评分，也有叠加边界模板（CT-template）的评分。通过联合裁决，由 2 名神经放射科医师生成金标准 ASPECTS。使用组内相关系数（ICC）评估全尺度一致性和 Gwet 的 AC1 评估二分类（ASPECTS 0-6 与 7-10）一致性来评估信度和准确性。
共纳入 82 例患者。对于 CT-native 和 CT-template，评估者间信度均随着培训水平的提高而提高（ICC 分别为 0.15、0.31、0.54，对于住院医师、神经科医师和放射科医师）。使用边界模板可提高与金标准的相关性，对于一名住院医师的全尺度一致性（ICC 从 0.01 提高至 0.31，P=0.01）和另一名住院医师的二分类一致性（AC1 从 0.36 提高至 0.64，P=0.01）有所改善，但对于其他评估者无差异。对于同水平的评估者，模板并未改善其 ICC。
ASPECTS 的评估者间信度随医师培训水平的提高而提高。在 NCCT 上对 ASPECTS 区域边界进行标准化显示并不能提高评估者间信度，但可能会提高一些经验较少的评估者的准确性。
