Region-specific agreement in ASPECTS estimation between neuroradiologists and e-ASPECTS software

Ain Neuhaus, Seyed Mohammad Seyedsaadat, David Mihal, John Benson, Ian Mark, David F. Kallmes, Waleed Brinjikji

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background and purpose The Alberta Stroke Program Early CT Score (ASPECTS) is a widely used measure of ischemic change on non-contrast CT. Although predictive of long-term outcome, ASPECTS is limited by its modest interobserver agreement. One potential solution to this is the use of machine learning strategies, such as e-ASPECTS, to detect ischemia. Here, we compared e-ASPECTS with manual scoring by experienced neuroradiologists for all 10 individual ASPECTS regions. Materials and methods We retrospectively reviewed 178 baseline non-contrast CT scans from patients with acute ischemic stroke undergoing endovascular thrombectomy. All scans were reviewed by two independent neuroradiologists with a third reader arbitrating disagreements for a consensus read. Each ASPECTS region was scored individually. All scans were then evaluated using a machine learning-based software package (e-ASPECTS, Brainomix). Interobserver agreement between readers and the software for each region was calculated with a kappa statistic. Results The median ASPECTS was 9 for manual scoring and 8.5 for e-ASPECTS, with an overall agreement of κ=0.248. Regional agreement varied from κ=0.094 (M1) to κ=0.555 (lentiform), with better performance in subcortical regions. When corrected for the low number of infarcts in any given region, prevalence-adjusted bias-adjusted kappa ranged from 0.483 (insula) to 0.888 (M3), with greater agreement for cortical areas. Intraclass correlation coefficients were between 0.09 (M1) and 0.556 (lentiform). Conclusion Manual scoring and e-ASPECTS had fair agreement in our dataset on a per-region basis. This warrants further investigation using follow-up scans or MRI as the gold standard measure of true ASPECTS.

Original languageEnglish (US)
Pages (from-to)720-723
Number of pages4
JournalJournal of neurointerventional surgery
Issue number7
StatePublished - Jul 1 2020


  • CT
  • stroke
  • thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


Dive into the research topics of 'Region-specific agreement in ASPECTS estimation between neuroradiologists and e-ASPECTS software'. Together they form a unique fingerprint.

Cite this