Validation of automated Alberta Stroke Program Early CT Score (ASPECTS) software for detection of early ischemic changes
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DIAGNOSTIC NEURORADIOLOGY
Validation of automated Alberta Stroke Program Early CT Score (ASPECTS) software for detection of early ischemic changes on non-contrast brain CT scans Lennard Wolff 1 & Olvert A. Berkhemer 1,2,3 & Adriaan C. G. M. van Es 1 & Wim H. van Zwam 4 & Diederik W. J. Dippel 1,3 & Charles B. L. M. Majoie 2 & Theo van Walsum 1,5 & Aad van der Lugt 1 & for the MR CLEAN Investigators Received: 25 June 2020 / Accepted: 17 August 2020 # The Author(s) 2020
Abstract Purpose In ASPECTS, 10 brain regions are scored visually for presence of acute ischemic stroke damage. We evaluated automated ASPECTS in comparison to expert readers. Methods Consecutive, baseline non-contrast CT-scans (5-mm slice thickness) from the prospective MR CLEAN trial (n = 459, MR CLEAN Netherlands Trial Registry number: NTR1804) were evaluated. A two-observer consensus for ASPECTS regions (normal/abnormal) was used as reference standard for training and testing (0.2/0.8 division). Two other observers provided individual ASPECTS-region scores. The Automated ASPECTS software was applied. A region score specificity of ≥ 90% was used to determine the software threshold for detection of an affected region based on relative density difference between affected and contralateral region. Sensitivity, specificity, and receiver-operating characteristic curves were calculated. Additionally, we assessed intraclass correlation coefficients (ICCs) for automated ASPECTS and observers in comparison to the reference standard in the test set. Results In the training set (n = 104), with software thresholds for a specificity of ≥ 90%, we found a sensitivity of 33–49% and an area under the curve (AUC) of 0.741–0.785 for detection of an affected ASPECTS region. In the test set (n = 355), the results for the found software thresholds were 89–89% (specificity), 41–57% (sensitivity), and 0.750–0.795 (AUC). Comparison of automated ASPECTS with the reference standard resulted in an ICC of 0.526. Comparison of observers with the reference standard resulted in an ICC of 0.383–0.464. Conclusion The performance of automated ASPECTS is comparable to expert readers and could support readers in the detection of early ischemic changes. Keywords Stroke . Tomography . X-Ray Computed . Brain ischemia . Image Processing . Computer-Assisted . Software validation
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00234-020-02533-6) contains supplementary material, which is available to authorized users. * Lennard Wolff [email protected]; https://www.linkedin.com/in/ lennardwolff/ 1
Department of Radiology & Nuclear Medicine, Erasmus MC, P. van Andel & L. Wolff, room Ne-515, Postbus 2040, 3000, CA Rotterdam, the Netherlands
2
Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands
3
Department of Neurology, Erasmus MC, Rotterdam, the Netherlands
4
Department of Radiology, Maastricht UMC+, Maastricht, the Netherlands
5
Biomedical Imaging Group Rotter
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