Tilt-Corrected Region Boundaries May Enhance the Alberta Stroke Program Early Computed Tomography Score for Less Experienced Raters.

Autor: Culbertson CJ; Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California. Electronic address: collinc@stanford.edu., Christensen S; Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California., Mlynash M; Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California., Heit JJ; Department of Diagnostic and Interventional Neuroradiology, Stanford University School of Medicine, Stanford, California., Federau C; Institute for Biomedical Engineering, ETH Zürich, Zürich, Switzerland., Sells CM; Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California., Legault C; Department of Neurology and Neurosurgery, McGill University at the Montreal Neurological Institute, Montreal, Quebec, Canada., McCaslin AFH; Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California., Werbaneth K; Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California., Albers GW; Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California., Lansberg MG; Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2020 Jul; Vol. 29 (7), pp. 104820. Date of Electronic Publication: 2020 Apr 16.
DOI: 10.1016/j.jstrokecerebrovasdis.2020.104820
Abstrakt: Background: The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is widely used to quantify early ischemic changes in the anterior circulation but has limited inter-rater reliability.
Aims: We investigated whether application of 3-dimensional boundaries outlining the ASPECTS regions improves inter-rater reliability and accuracy.
Methods: We included all patients from our DEFUSE 2 database who had a pretreatment noncontrast computed tomography scan (NCCT) of acceptable quality. Six raters (2 neuroradiologists, 2 vascular neurologists, and 2 neurology residents) scored ASPECTS of each NCCT without ("CT-native") and with the superimposed boundary template ("CT-template"). Gold-standard ASPECTS were generated by the 2 neuroradiologists through joint adjudication. Inter-rater reliability and accuracy were assessed using the intraclass correlation coefficient (ICC) for full-scale agreements and Gwet's AC1 for dichotomized (ASPECTS 0-6 vs 7-10) agreements.
Results: Eighty-two patients were included. Inter-rater reliability improved with higher training level for both CT-native (ICC = .15, .31, .54 for residents, neurologists, and radiologists, respectively) and CT-template (ICC = .18, .33, .56). Use of the boundary template improved correlation with the gold-standard for one resident on full-scale agreement (ICC increased from .01 to .31, P = .01) and another resident on dichotomized agreement (AC1 increased from .36 to .64, P = .01), but resulted in no difference for other raters. The template did not improve ICC between raters of the same training level.
Conclusions: Inter-rater reliability of ASPECTS improves with physician training level. Standardized display of ASPECTS region boundaries on NCCT does not improve inter-rater reliability but may improve accuracy for some less experienced raters.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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