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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleAdult Brain
Open Access

Automated ASPECTS in Acute Ischemic Stroke: A Comparative Analysis with CT Perfusion

V.K. Sundaram, J. Goldstein, D. Wheelwright, A. Aggarwal, P.S. Pawha, A. Doshi, J.T. Fifi, R. De Leacy, J. Mocco, J. Puig and K. Nael
American Journal of Neuroradiology December 2019, 40 (12) 2033-2038; DOI: https://doi.org/10.3174/ajnr.A6303
V.K. Sundaram
aFrom the Department of Radiology (V.K.S., J.G., A.A., P.P., A.D., K.N.)
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  • ORCID record for V.K. Sundaram
J. Goldstein
aFrom the Department of Radiology (V.K.S., J.G., A.A., P.P., A.D., K.N.)
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D. Wheelwright
bNeuroimaging Advanced and Exploratory Lab, Department of Neurology (D.W., J.T.F., R.D.L.)
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A. Aggarwal
aFrom the Department of Radiology (V.K.S., J.G., A.A., P.P., A.D., K.N.)
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P.S. Pawha
aFrom the Department of Radiology (V.K.S., J.G., A.A., P.P., A.D., K.N.)
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A. Doshi
aFrom the Department of Radiology (V.K.S., J.G., A.A., P.P., A.D., K.N.)
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J.T. Fifi
bNeuroimaging Advanced and Exploratory Lab, Department of Neurology (D.W., J.T.F., R.D.L.)
cDepartment of Neurosurgery (J.T.F., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, New York
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R. De Leacy
bNeuroimaging Advanced and Exploratory Lab, Department of Neurology (D.W., J.T.F., R.D.L.)
cDepartment of Neurosurgery (J.T.F., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, New York
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J. Mocco
cDepartment of Neurosurgery (J.T.F., R.D.L., J.M.), Icahn School of Medicine at Mount Sinai, New York, New York
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J. Puig
dDepartment of Radiology (J.P.). University of Manitoba, Winnipeg, Manitoba, Canada.
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K. Nael
aFrom the Department of Radiology (V.K.S., J.G., A.A., P.P., A.D., K.N.)
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    Fig 1.

    Comparative illustration of the distribution of ASPECTS from consensus reads of 2 neuroradiologists, software-based automated ASPECTS, and CTP-CBV for all patients in our study population (each marker represents a patient’s score). Automated ASPECTS showed excellent agreement (κ = 0.84; 95% CI, 0.62–1.0) with both consensus and CTP-CBV ASPECTS. The intraclass correlation coefficient was 0.84 (95% CI, 0.76–0.90) across all 3 groups.

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    Fig 2.

    An 82-year-old woman who presented with right MCA M1 occlusion and an NIHSS score of 18. She underwent successful mechanical thrombectomy (TICI 3) with a CT-to-recanalization time of 50 minutes. Axial NCCT (A), automated ASPECTS (B), axial CTP-CBV (C), and axial NCCT 48 hours after endovascular treatment (D) are shown. For the 2 human readers, one scored 6 and the other, 7 (consensus ASPECTS, 6). B, Automated software assigned an ASPECTS of 6. CTP-CBV ASPECTS was 7. There is good topographic correlation with the final infarction volume.

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    Fig 3.

    Scatterplots for correlation between ASPECTS and final infarction volume for all 3 ASPECTS groups showing significant (P < .001) negative correlation (r = −0.52 for the consensus reads, −0.58 for CTP-CBV, and −0.66 for automated ASPECTS).

Tables

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    Table 1:

    Comparative analysis among ASPECTS scores categorized on the basis of time of symptom onseta

    Onset Symptoms ≤6 hrs (24)Onset Symptoms >6 hrs (34)P Value
    Consensus ASPECTS (2 neuroradiologists)8 (6–9)7 (7–9).46
    Automated ASPECTS9 (7–10)9 (8–9).64
    CTP-CBV ASPECTS8 (6–9)8 (7–9).73
    • ↵a Data are presented in median (IQR).

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    Table 2:

    Clinical and imaging data in patients with good-versus-poor functional outcome using mRS >2 as a cutoff

    VariableOverall (n = 50)Good Outcome (n = 22)Poor Outcome (n = 28)P Value
    Age (mean) (SD) (yr)70.0 (13.0)65.1 (12.8)73.8 (12.1).02
    Sex (M/F)23:2713:910:18.10
    Baseline NIHSS (median) (IQR)15 (11–21)11 (8–14)20 (14–22).001
    Time from symptom onset (mean) (SD) (hr)8.4 (5.6)8.8 (6.7)8.1 (4.6).62
    Consensus ASPECTS ≥ 6 (No.) (%)4321 (95%)22 (78%).10
    Automated ASPECTS ≥ 6 (No.) (%)4521 (95%)24 (85%).26
    CTP-CBV ASPECTS ≥ 6 (No.) (%)4321 (95%)22 (78%).10
    Final infarction volume (mean) (SD) (mL)4924.4 (29.0)57.5 (64.7).03
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American Journal of Neuroradiology: 40 (12)
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V.K. Sundaram, J. Goldstein, D. Wheelwright, A. Aggarwal, P.S. Pawha, A. Doshi, J.T. Fifi, R. De Leacy, J. Mocco, J. Puig, K. Nael
Automated ASPECTS in Acute Ischemic Stroke: A Comparative Analysis with CT Perfusion
American Journal of Neuroradiology Dec 2019, 40 (12) 2033-2038; DOI: 10.3174/ajnr.A6303

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Automated ASPECTS in Acute Ischemic Stroke: A Comparative Analysis with CT Perfusion
V.K. Sundaram, J. Goldstein, D. Wheelwright, A. Aggarwal, P.S. Pawha, A. Doshi, J.T. Fifi, R. De Leacy, J. Mocco, J. Puig, K. Nael
American Journal of Neuroradiology Dec 2019, 40 (12) 2033-2038; DOI: 10.3174/ajnr.A6303
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