Sakai Kenichiro, Komatsu Teppei, Iguchi Yasuyuki, Takao Hiroyuki, Ishibashi Toshihiro, Murayama Yuichi
Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Japan.
J Med Internet Res. 2020 Jun 9;22(6):e15893. doi: 10.2196/15893.
High-quality neuroimages can be viewed using a medical app installed on a smartphone. Although interdevice agreement between smartphone and desktop PC monitor was found to be favorable for evaluating computed tomography images, there are no interdevice agreement data for diffusion-weighted imaging (DWI).
The aim of our study was to compare DWI interpretation using the Join smartphone app with that using a desktop PC monitor, in terms of interdevice and interrater agreement and elapsed interpretation time.
The ischemic change in the DWI of consecutive patients with acute stroke in the middle cerebral artery territory was graded by 2 vascular neurologists using the Join smartphone app and a desktop PC monitor. The vascular neurologists were blinded to all patient information. Each image was categorized as either Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores (DWI-ASPECTS) ≥7 or DWI-ASPECTS <7 according to the Japanese Society for Neuroendovascular Therapy. We analyzed interdevice agreement and interrater agreement with respect to DWI-ASPECTS. Elapsed interpretation time was compared between DWI-ASPECTS evaluated by the Join smartphone app and a desktop PC monitor.
We analyzed the images of 111 patients (66% male; median age=69 years; median National Institutes of Health Stroke Scale score on admission=4). Interdevice agreement regarding DWI-ASPECTS between the smartphone and the desktop PC monitor was favorable (vascular neurologist 1: κ=0.777, P<.001, vascular neurologist 2: κ=0.787, P<.001). Interrater agreement was also satisfactory for the smartphone (κ=0.710, P<.001) and the desktop PC monitor (κ=0.663, P<.001). Median elapsed interpretation time was similar between the smartphone and the desktop PC monitor (vascular neurologist 1: 1.7 min vs 1.6 min; P=.64); vascular neurologist 2: 2.4 min vs 2.0 min; P=.14).
The use of a smartphone app enables vascular neurologists to estimate DWI-ASPECTS accurately and rapidly. The Join medical smartphone app shows great promise in the management of acute stroke.
可使用安装在智能手机上的医学应用程序查看高质量的神经影像。尽管发现智能手机与台式电脑显示器之间的设备间一致性有利于评估计算机断层扫描图像，但对于扩散加权成像（DWI）尚无设备间一致性数据。
我们研究的目的是在设备间和评估者间一致性以及评估用时方面，比较使用Join智能手机应用程序与使用台式电脑显示器对DWI的解读。
由2名血管神经科医生使用Join智能手机应用程序和台式电脑显示器，对大脑中动脉区域急性卒中连续患者的DWI缺血性改变进行分级。血管神经科医生对所有患者信息不知情。根据日本神经血管内治疗学会的标准，将每张图像分类为扩散加权成像-艾伯塔卒中项目早期计算机断层扫描评分（DWI-ASPECTS）≥7或DWI-ASPECTS<7。我们分析了关于DWI-ASPECTS的设备间一致性和评估者间一致性。比较了通过Join智能手机应用程序和台式电脑显示器评估DWI-ASPECTS的用时。
我们分析了111例患者的图像（男性占66%；中位年龄=69岁；入院时美国国立卫生研究院卒中量表中位评分=4）。智能手机与台式电脑显示器之间关于DWI-ASPECTS的设备间一致性良好（血管神经科医生1：κ=0.777，P<.001；血管神经科医生2：κ=0.787，P<.001）。智能手机（κ=0.710，P<.001）和台式电脑显示器（κ=0.663，P<.001）的评估者间一致性也令人满意。智能手机和台式电脑显示器的中位评估用时相似（血管神经科医生1：1.7分钟对1.6分钟；P=.64）；血管神经科医生2：2.4分钟对2.0分钟；P=.14）。
使用智能手机应用程序使血管神经科医生能够准确、快速地评估DWI-ASPECTS。Join医学智能手机应用程序在急性卒中管理中显示出巨大潜力。
