Accuracy and Prognostic Role of NCCT-ASPECTS Depend on Time from Acute Stroke Symptom-onset for both Human and Machine-learning Based Evaluation.

Potreck, A; Weyland, C S; Seker, F; Neuberger, U; Herweh, C; Hoffmann, A; Nagel, S; Bendszus, M; Mutke, M A (2022). Accuracy and Prognostic Role of NCCT-ASPECTS Depend on Time from Acute Stroke Symptom-onset for both Human and Machine-learning Based Evaluation. Clinical neuroradiology, 32(1), pp. 133-140. Springer-Verlag 10.1007/s00062-021-01110-5

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PURPOSE

We hypothesize that the detectability of early ischemic changes on non-contrast computed tomography (NCCT) is limited in hyperacute stroke for both human and machine-learning based evaluation. In short onset-time-to-imaging (OTI), the CT angiography collateral status may identify fast stroke progressors better than early ischemic changes quantified by ASPECTS.

METHODS

In this retrospective, monocenter study, CT angiography collaterals (Tan score) and ASPECTS on acute and follow-up NCCT were evaluated by two raters. Additionally, a machine-learning algorithm evaluated the ASPECTS scale on the NCCT (e-ASPECTS). In this study 136 patients from 03/2015 to 12/2019 with occlusion of the main segment of the middle cerebral artery, with a defined symptom-onset-time and successful mechanical thrombectomy (MT) (modified treatment in cerebral infarction score mTICI = 2c or 3) were evaluated.

RESULTS

Agreement between acute and follow-up ASPECTS were found to depend on OTI for both human (Intraclass correlation coefficient, ICC = 0.43 for OTI < 100 min, ICC = 0.57 for OTI 100-200 min, ICC = 0.81 for OTI ≥ 200 min) and machine-learning based ASPECTS evaluation (ICC = 0.24 for OTI < 100 min, ICC = 0.61 for OTI 100-200 min, ICC = 0.63 for OTI ≥ 200 min). The same applied to the interrater reliability. Collaterals were predictors of a favorable clinical outcome especially in hyperacute stroke with OTI < 100 min (collaterals: OR = 5.67 CI = 2.38-17.8, p < 0.001; ASPECTS: OR = 1.44, CI = 0.91-2.65, p = 0.15) while ASPECTS was in prolonged OTI ≥ 200 min (collaterals OR = 4.21,CI = 1.36-21.9, p = 0.03; ASPECTS: OR = 2.85, CI = 1.46-7.46, p = 0.01).

CONCLUSION

The accuracy and reliability of NCCT-ASPECTS are time dependent for both human and machine-learning based evaluation, indicating reduced detectability of fast stroke progressors by NCCT. In hyperacute stroke, collateral status from CT-angiography may help for a better prognosis on clinical outcome and explain the occurrence of futile recanalization.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Hoffmann, Angelika

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1869-1447

Publisher:

Springer-Verlag

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

12 Apr 2022 17:10

Last Modified:

05 Dec 2022 16:18

Publisher DOI:

10.1007/s00062-021-01110-5

Related URLs:

PubMed ID:

34709408

Uncontrolled Keywords:

Brain CT angiography Computed tomography Stroke Thrombectomy

BORIS DOI:

10.48350/169243

URI:

https://boris.unibe.ch/id/eprint/169243

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