Automated ASPECTS in acute ischemic stroke: comparison of the overall scores and Hounsfield unit values of two software packages and radiologists with different levels of experience.

BACKGROUND: ASPECTS is a simple, rapid, and semi-quantitative method for detecting early ischemic changes (EIC). However, the agreement between software applications and neuroradiologists varies greatly. PURPOSE: To compare ASPECTS calculated by using automated software tools to neuroradiologists evaluation in patients with acute ischemic stroke (AIS). MATERIAL AND METHODS: Retrospectively, 61 patients with large vessel occlusion (LVO) who underwent multimodal stroke computed tomography (CT) were evaluated using two automated ASPECTS software tools (NSK and RAPID) and three neuroradiologists with different experiences (two senior neuroradiologists and one junior neuroradiologist). Four weeks later, the same three neuroradiologists re-evaluated the ASPECTS in consensus using the baseline CT and follow-up non-contrast CT (NCCT). Interclass correlation coefficients (ICCs) and Pearson correlation coefficients were applied for statistical analysis. RESULTS: The HU value exhibited the greatest correlation in the insular lobe (r = 0.81; P < 0.001) and the lowest correlation in the internal capsule (r = 0.65; P < 0.001) between NSK and RAPID. Software analysis and human readers showed excellent agreement with the consensus reading. Compared with the consensus reading, the correlation of the two senior radiologists (ICC = 0.975 and 0.969, respectively) were higher than that of junior radiologist (ICC = 0.869), and the consistency values of the NSK and RAPID software tools after 6 h of onset to imaging (ICC = 0.894 and 0.874, respectively) were greater than those within 6 h of onset (ICC = 0.746 and 0.828, respectively). CONCLUSION: For patients experiencing AIS due to LVO, the ASPECTS calculated with automated software agrees well with the predefined consensus score but is inferior to that of senior radiologists.