Per-region interobserver agreement of Alberta Stroke Program Early CT Scores (ASPECTS)

Nicholson, Patrick; Hilditch, Christopher Alan; Neuhaus, Anneke; Seyedsaadat, Seyed Mohammad; Benson, John C.; Mark, Ian T.; Tsang, Chun On Anderson; Schaafsma, Joanna D.; Kallmes, David F.; Krings, Timo; Brinjikji, Waleed

doi:10.1136/neurintsurg-2019-015473

Cited by 22 publications

(30 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In line with our findings, Nicholson et al. [ 24 ] reported the highest level of agreement for the insular cortex, with a κ = 0.56 (Cohen’s κ), the lowest being observed in the M3 (κ = 0.34) and internal capsule (κ = 0.44) regions. Similarly, the four observers in the study conducted by Finlayson et al.…”

Section: Discussionsupporting

confidence: 92%

“…Interrater agreement differs remarkably for both total ASPECTS and the individual ASPECTS regions [ 24 ]. In our dataset, a wide frequency distribution for total ASPECTS evaluation was found.…”

Section: Discussionmentioning

confidence: 99%

“…Yet another recently conducted study by Nicholson et al. [ 24 ] found that overall agreement was relatively good, with a κ = 0.66 (Cohen’s κ) at an ASPECTS threshold of 5.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

ASPECTS Interobserver Agreement of 100 Investigators from the TENSION Study

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

ASPECTS Interobserver Agreement of 100 Investigators from the TENSION Study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…First, there is a wide range in the reported rates of interobserver and intra-observer agreement in the scoring of ASPECTS. [9][10][11] Second, chronic infarcts or adjacent white matter disease may confound scoring. Because ASPECTS relies on detection of subtle reductions in parenchymal attenuation, some of which may be beyond the ability of a human reader to consistently detect, grading of ASPECTS is a potentially excellent application of machine learning and artificial intelligence based imaging analysis.…”

Section: Introductionmentioning

confidence: 99%

e-ASPECTS software improves interobserver agreement and accuracy of interpretation of aspects score

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction There is increased interest in the use of artificial intelligence-based (AI) software packages in the evaluation of neuroimaging studies for acute ischemic stroke. We studied whether, compared to standard image interpretation without AI, Brainomix e-ASPECTS software improved interobserver agreement and accuracy in detecting ASPECTS regions affected in anterior circulation LVO. Methods We included 60 consecutive patients with anterior circulation LVO who had TICI 3 revascularization within 60 minutes of their baseline CT. A total of 16 readers, including senior neuroradiologists, junior neuroradiologists and vascular neurologists participated. Readers interpreted CT scans on independent workstations and assessed final ASPECTS and evaluated whether each individual ASPECTS region was affected. Two months later, readers again evaluated the CT scans, but with assistance of e-ASPECTS software. We assessed interclass correlation coefficient for total ASPECTS and interobserver agreement with Fleiss’ Kappa for each ASPECTS region with and without assistance of the e-ASPECTS. We also assessed accuracy for the readers with and without e-ASPECTS assistance. In our assessment of accuracy, ground truth was the 24 hour CT in this cohort of patients who had prompt and complete revascularization. Results Interclass correlation coefficient for total ASPECTS without e-ASPECTS assistance was 0.395, indicating fair agreement compared, to 0.574 with e-ASPECTS assistance, indicating good agreement (P < 0.01). There was significant improvement in inter-rater agreement with e-ASPECTS assistance for each individual region with the exception of M6 and caudate. The e-ASPECTS software had higher accuracy than the overall cohort of readers (with and without e-ASPECTS assistance) for every region except the caudate. Conclusions Use of Brainomix e-ASPECTS software resulted in significant improvements in inter-rater agreement and accuracy of ASPECTS score evaluation in a large group of neuroradiologists and neurologists. e-ASPECTS software was more predictive of final infarct/ASPECTS than the overall group interpreting the CT scans with and without e-ASPECTS assistance.

show abstract

“…A korai ischaemiás CT-jelek kimutatása gyakorlott radiológus számára is lehet kihívás, ezért az ASPECTSrendszer megfelelő alkalmazása is gyakorlatot igényel. Mivel az ASPECTS-rendszernél a vizsgálók közötti egyezés mértéke részben vitatott, ennek standardizálása mindenképp szükségszerű volt [20]. Az elmúlt években fejlesztettek ki olyan mesterségesintelligencia-módszereken alapuló algoritmusokat, melyek a CT-felvételeket az ASPECTS-rendszer szerint rövid idő alatt reprodukálhatóan értékelik, azaz az automatikus régiófelismerés után a denzitáseltéréseket kvantifikálják [21].…”

Section: Képalkotó Diagnosztikaunclassified

Stroke-ellátást támogató teleradiológiai hálózat a Nyugat- és Dél-Dunántúlon

Bogner

Chadaide

Lenzsér

et al. 2021

View full text Add to dashboard Cite

Összefoglaló. Bevezetés: A stroke kezelésének lehetőségei az utóbbi években jelentősen megváltoztak: a thrombolysis után bevezetésre került a mechanikus thrombectomia, és a terápiás időablak is jelentősen kitágult az utóbbi évek nagy multicentrikus tanulmányai alapján. Ezek a lehetőségek új igényeket fogalmaztak meg a képalkotó diagnosztikával szemben: az ischaemia okozta morfológiai elváltozások mellett az artériás és a kollaterális rendszer állapotát, valamint bizonyos esetekben az agy szöveti perfúzióját is szükséges meghatározni. Ezeket a komplex kiértékelési feladatokat ma már mesterségesintelligencia-algoritmusok támogathatják, melyek a kiértékelést pár perc alatt elvégezve segítenek a terápiás döntés kialakításában. Célkitűzés: A Dél- és a Nyugat-dunántúli régióban hat intézmény részvételével egy dedikált stroke teleradiológiai hálózat kialakítása. Módszer: A stroke-CT-kiértékelő szoftver és a képkommunikáció integrációja, a vizsgálati protokollok technikai paramétereinek egységesítése, a kiértékelési eredmények teleradiológiai megjelenítése valósult meg a hálózat kialakítása során. Eredmények: A hálózat egységesítette nemcsak a stroke-CT-protokollok beállításait, de beutalási és értékelési szempontjait is. A stroke-CT-kiértékelések és a mechanikus thrombectomiák száma is emelkedett az elmúlt egy évben. Következtetés: A dedikált teleradiológiai stroke-hálózat segítségével optimalizálni kívánjuk a régió stroke-ellátását: egyrészt lehetőleg ne maradjanak ellátatlanul a thrombectomiából valószínűleg profitáló betegek, másrészt ne terheljük az ellátórendszert olyan esetekkel, melyekről a teljes dokumentáció ismeretében derül ki, hogy nem javasolt a beavatkozás. Orv Hetil. 2021; 162(17): 668–675. Summary. Introduction: The possibilities of cerebral stroke management have changed substantially during the last few years. Following a few multicentric studies, mechanical thrombectomy became an established method besides thrombolysis. In addition, the therapeutic window for both methods is much wider now than before. These changes described above demanded more information of CT morphological changes due to ischemia, but the condition and functionality of the arterial and collateral system, and occasionally tissue perfusion performance should also be characterized. Recently, evaluation of different computer tomographic (CT) measurements can be done using artificial intelligence based methods, which perform data analysis in a few minutes. Objective: To establish a dedicated stroke teleradiology network with artificial intelligence based image analysis in Western and Southern Transdanubia in Hungary that involves six partner institutes. Method: Integration of automated image analysis with teleradiology software was established, and the technical parameters of examination protocols were unified. Results of stroke CT image analysis became accessible through the teleradiology network. Results: The daily use of integrated central image analysis and image communication had a positive impact on referrals and therapeutic evaluation of stroke cases. The number of image processing and mechanical thrombectomy increased during the last year. Conclusion: With the help of the dedicated teleradiology stroke network, we want to optimize the stroke care in the region: on the one hand, patients who are likely to benefit from thrombectomy should not be left unattended, on the other, the health care system should not be burdened with cases, when intervention is not recommended having the complete clinical data accessed. Orv Hetil. 2021; 162(17): 668–675.

show abstract

Per-region interobserver agreement of Alberta Stroke Program Early CT Scores (ASPECTS)

Cited by 22 publications

References 9 publications

ASPECTS Interobserver Agreement of 100 Investigators from the TENSION Study

ASPECTS Interobserver Agreement of 100 Investigators from the TENSION Study

e-ASPECTS software improves interobserver agreement and accuracy of interpretation of aspects score

Stroke-ellátást támogató teleradiológiai hálózat a Nyugat- és Dél-Dunántúlon

Contact Info

Product

Resources

About