e-ASPECTS software is non-inferior to neuroradiologists in applying the ASPECT score to computed tomography scans of acute ischemic stroke patients
e-ASPECTS software is non-inferior to neuroradiologists in applying the ASPECT score to computed tomography scans of acute ischemic stroke patients
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DOI：
10.1177/1747493016681020
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发表时间：
2017-08-01
影响因子：
6.7
通讯作者：
Grunwald, Iris Q.
中科院分区：
文献类型：
--
作者：
Nagel, Simon;Sinha, Devesh;Grunwald, Iris Q.
背景：艾伯塔省中风计划早期计算机断层扫描评分 (ASPECTS) 是一项既定的 10 分定量地形计算机断层扫描评分，用于评估早期缺血性变化。我们在 e-ASPECTS 软件和神经放射科医生之间进行了一项非劣效性试验，对急性缺血性卒中患者的非造影增强计算机断层扫描图像的 ASPECTS 进行评分。 方法：在这项多中心研究中，e-ASPECTS 和三位独立的神经放射科医生回顾性、盲法评估了 132 名急性前循环缺血性卒中患者的基线非造影增强计算机断层扫描图像。后续扫描作为确定梗塞明确区域的基础事实。计算基于区域和评分的分析的敏感性、特异性和准确性、接受者操作特征曲线、Bland-Altman 图和相对于真实情况的 Matthews 相关系数，并在神经放射科医生和不同的预先指定的 e-ASPECTS 操作点之间进行比较。基于区域的分析的敏感性和特异性的非劣效性界值均设置为 10%。 结果：对总共 2640 个（132 名患者 x 每个患者 20 个区域）ASPECTS 区域进行了评分。从发病到基线计算机断层扫描的平均时间为 146 +/- 124 分钟，NIH 卒中量表 (NIHSS) 中位数为 11（6-17，四分位数范围）。后续成像的地面实况方面的中位数为 8（6.5-9，四分位距）。在基于区域的分析中，两个 e-ASPECTS 操作点（敏感性、特异性和准确性分别为 44%、93%、87% 和 44%、91%、85%）在统计上不劣于所有三位神经放射科医生（所有 p 值）
Background: The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is an established 10-point quantitative topographic computed tomography scan score to assess early ischemic changes. We performed a non-inferiority trial between the e-ASPECTS software and neuroradiologists in scoring ASPECTS on non-contrast enhanced computed tomography images of acute ischemic stroke patients.Methods: In this multicenter study, e-ASPECTS and three independent neuroradiologists retrospectively and blindly assessed baseline non-contrast enhanced computed tomography images of 132 patients with acute anterior circulation ischemic stroke. Follow-up scans served as ground truth to determine the definite area of infarction. Sensitivity, specificity, and accuracy for region-and score-based analysis, receiver-operating characteristic curves, Bland-Altman plots and Matthews correlation coefficients relative to the ground truth were calculated and comparisons were made between neuroradiologists and different pre-specified e-ASPECTS operating points. The non-inferiority margin was set to 10% for both sensitivity and specificity on region-based analysis.Results: In total 2640 (132 patients x 20 regions per patient) ASPECTS regions were scored. Mean time from onset to baseline computed tomography was 146 +/- 124 min and median NIH Stroke Scale (NIHSS) was 11 (6-17, inter-quartile range). Median ASPECTS for ground truth on follow-up imaging was 8 (6.5-9, interquartile range). In the region-based analysis, two e-ASPECTS operating points (sensitivity, specificity, and accuracy of 44%, 93%, 87% and 44%, 91%, 85%) were statistically non-inferior to all three neuroradiologists (all p-values