Neurology International (Nov 2022)

The Utility of Automated ASPECTS in Acute Ischemic Stroke for Intravenous Recombinant Tissue Plasminogen Activator (IV-rtPA) Therapy

  • Soichiro Shibata,
  • Kenzo Sakurai,
  • Keiji Tachikawa,
  • Riyoko Ko,
  • Sakae Hino,
  • Takayuki Fukano,
  • Kenji Isahaya,
  • Takafumi Haraguchi,
  • Junji Yamauchi,
  • Kenichiro Tanabe,
  • Misako Nagasaka,
  • Yuta Hagiwara,
  • Takahiro Shimizu,
  • Hisanao Akiyama,
  • Yasuyuki Kobayashi,
  • Yasuhiro Hasegawa,
  • Yoshihisa Yamano

DOI
https://doi.org/10.3390/neurolint14040077
Journal volume & issue
Vol. 14, no. 4
pp. 981 – 990

Abstract

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Purpose: This study aimed to investigate the accuracy and clinical significance of an artificial intelligence (AI)-based automated Alberta Stroke Program Early Computed Tomography (ASPECT) scoring software of head CT for the indication of intravenous recombinant tissue plasminogen activator (rt-PA) therapy. Methods: This study included two populations of acute ischemic stroke: one comprised patients who had undergone head CT within 48 h of presentation (Population #1, n = 448), while the other included patients within 4.5 h from onset (Population #2, n = 132). The primary endpoint was the concordance rate of ASPECTS of the neurologists and AI software against the benchmark score. The secondary endpoints were to validate the accuracy of the neurologist and AI software in assessing the ability to rule out extensive infarction (ASPECTS of 0–5) in population #2. Results: The reading accuracy of AI software was comparable to that of the board-certified vascular neurologists. The detection rate of cardiogenic cerebral embolism was better than that of atherothrombotic cerebral infarction. By excluding extensive infarction, AI-software showed a higher specificity and equivalent sensitivity compared to those of experts. Conclusions: The AI software for ASPECTS showed convincing agreement with expert evaluation and would be supportive in determining the indications of intravenous rt-PA therapy.

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