External Validation of <scp>e‐ASPECTS</scp> Software for Interpreting Brain CT in Stroke

Mair, Grant; White, Philip; Bath, Philip M.; Muir, Keith W.; Salman, Rustam Al‐Shahi; Martin, Chloé; Dye, David; Chappell, Francesca M; Vacek, Adam; Kummer, Rüdiger von; Macleod, Malcolm; Sprigg, Nikola

doi:10.1002/ana.26495

Cited by 17 publications

(31 citation statements)

References 40 publications

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“…In this analysis of e‐CTA, we: Aimed for age, sex, stroke severity and time since symptom onset similar to results provided by UK national audit (SSNAP, April 2018–March 2019, www.strokeaudit.org), and pooled randomised‐controlled trial data 1,18 . We expected RITeS patients to be within the ranges presented by the other datasets 10,11 . If necessary, we used stratified random sampling to modify the case mix. Did not exclude imaging based solely on quality, if intracranial arterial occlusion involved vessels other than the ICA‐MCA axis, or if the centrally adjudicated final diagnosis (derived using all available clinical and imaging data) was not ischemic stroke (a small number of patients were given a final diagnosis of stroke mimic). …”

Section: Methodsmentioning

confidence: 99%

“…We have previously described the RITeS (Real‐world Independent Testing of e‐ASPECTS Software) study, 10 , 11 a collaboration of up to 10 multicentre national and international acute stroke studies that recruited patients within 6 h of symptom onset. For the present analysis, we identified all patients in RITeS with CTA acquired at baseline.…”

Section: Methodsmentioning

confidence: 99%

“…We have previously described our method for deriving a ‘real‐world’ clinically representative dataset from all patients available to RITeS. 10 , 11 In this analysis of e‐CTA, we: Aimed for age, sex, stroke severity and time since symptom onset similar to results provided by UK national audit (SSNAP, April 2018–March 2019, www.strokeaudit.org ), and pooled randomised‐controlled trial data. 1 , 18 We expected RITeS patients to be within the ranges presented by the other datasets.…”

Section: Methodsmentioning

confidence: 99%

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Accuracy of artificial intelligence software for CT angiography in stroke

Mair

White

Bath

et al. 2023

Ann Clin Transl Neurol

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Objective Software developed using artificial intelligence may automatically identify arterial occlusion and provide collateral vessel scoring on CT angiography (CTA) performed acutely for ischemic stroke. We aimed to assess the diagnostic accuracy of e‐CTA by Brainomix™ Ltd by large‐scale independent testing using expert reading as the reference standard. Methods We identified a large clinically representative sample of baseline CTA from 6 studies that recruited patients with acute stroke symptoms involving any arterial territory. We compared e‐CTA results with masked expert interpretation of the same scans for the presence and location of laterality‐matched arterial occlusion and/or abnormal collateral score combined into a single measure of arterial abnormality. We tested the diagnostic accuracy of e‐CTA for identifying any arterial abnormality (and in a sensitivity analysis compliant with the manufacturer's guidance that software only be used to assess the anterior circulation). Results We include CTA from 668 patients (50% female; median: age 71 years, NIHSS 9, 2.3 h from stroke onset). Experts identified arterial occlusion in 365 patients (55%); most (343, 94%) involved the anterior circulation. Software successfully processed 545/668 (82%) CTAs. The sensitivity, specificity and diagnostic accuracy of e‐CTA for detecting arterial abnormality were each 72% (95% CI = 66–77%). Diagnostic accuracy was non‐significantly improved in a sensitivity analysis excluding occlusions from outside the anterior circulation (76%, 95% CI = 72–80%). Interpretation Compared to experts, the diagnostic accuracy of e‐CTA for identifying acute arterial abnormality was 72–76%. Users of e‐CTA should be competent in CTA interpretation to ensure all potential thrombectomy candidates are identified.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Accuracy of artificial intelligence software for CT angiography in stroke

Mair

White

Bath

et al. 2023

Ann Clin Transl Neurol

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“…While there is potential for these tools to increase appropriate utilization of reperfusion, expert oversight is still required and final proof of feasibility needs to be established. 70 Priorities for reperfusion approaches are summarized in Table 3.…”

Section: Identification Of Reperfusion-eligible Patientsmentioning

confidence: 99%

Most Promising Approaches to Improve Stroke Outcomes: The Stroke Treatment Academic Industry Roundtable XII Workshop

Wechsler,

Adeoye,

Alemseged

et al. 2023

Stroke

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The Stroke Treatment Academic Industry Roundtable XII included a workshop to discuss the most promising approaches to improve outcome from acute stroke. The workshop brought together representatives from academia, industry, and government representatives. The discussion examined approaches in 4 epochs: pre-reperfusion, reperfusion, post-reperfusion, and access to acute stroke interventions. The participants identified areas of priority for developing new and existing treatments and approaches to improve stroke outcomes. Although many advances in acute stroke therapy have been achieved, more work is necessary for reperfusion therapies to benefit the most possible patients. Prioritization of promising approaches should help guide the use of resources and investigator efforts.

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“…Per our recent Annals publication 1 and pre‐specified statistical analysis plan, 2 RITeS had two co‐primary outcomes: Compare ASPECTS 3 results provided by software to those of experts, and Test the diagnostic accuracy of software for identifying imaging features of stroke. …”

Section: Potential Conflict Of Interestmentioning

confidence: 99%