{
  "abstract": "Background The Alberta Stroke Program Early CT Score (ASPECTS) and CT angiography (CTA) Collateral Score (CS) are routinely used to estimate ischemic core burden and collateral status in acute ischemic stroke due to large vessel occlusion, but suffer from limited reliability. Whether automated CT perfusion (CTP) maps improve scoring consistency remains unclear.Objectives To assess the reliability of these scores on non-contrast computed tomography (NCCT) and CTA among numerous raters, with and without access to automated perfusion maps, and their correlations with endovascular thrombectomy (EVT) decisions.Methods Twenty-nine clinicians independently rated 60 imaging cases from 30 late-window stroke patients with large vessel occlusion, each presented twice: once using NCCT and CTA alone (‘non-CTP cases’), and once with the addition of perfusion maps (‘CTP cases’). Twenty-eight raters (97%) completed the survey twice. Inter- and intra-reliability was assessed using Gwet’s AC1/2 coefficients (κ G). Correlations with EVT decisions were evaluated using Cramer V.Results Inter-rater reliability for ASPECTS was substantial and similar between non-CTP (κ G = 0.65, 95% CI: 0.53 to 0.78) and CTP cases (κG = 0.64, 95% CI: 0.51 to 0.77). CS showed an almost perfect reliability in both scenarios (κG= 0.82 and 0.83). Intra-rater agreement was at least substantial. Dichotomizing ASPECTS as 0-2/3-10 improved reliability to almost perfect. ASPECTS strongly correlated with EVT decisions (V=0.80), whereas CS showed moderate correlation (V=0.56), both remaining similar with the addition of CTP (V=0.75 and 0.54, respectively).Conclusion Automated perfusion imaging did not improve the reliability of ASPECTS or CS. Strong reliability was achieved with NCCT and CTA alone.",
  "authors": [
    {
      "affiliations": [
        "Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael’s Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Anass Benomar"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada"
      ],
      "name": "Robert Fahed"
    },
    {
      "affiliations": [
        "Department of Surgery, Division of Neurosurgery, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada",
        "Division of Neurosurgery, University of the Philippines-Philippine General Hospital Department of Surgery, Manila, Philippines"
      ],
      "name": "Abdelsimar Tan Omar"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"
      ],
      "name": "Christine Hawkes"
    },
    {
      "affiliations": [
        "Joint Department of Medical Imaging (JDMI), Division of Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Eef J Hendriks"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"
      ],
      "name": "Clare A Enriquez"
    },
    {
      "affiliations": [
        "Department of Radiology, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Muneer Eesa"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada"
      ],
      "name": "Grant Stotts"
    },
    {
      "affiliations": [
        "Department of Surgery, Division of Neurosurgery, Royal Inland Hospital, Kamloops, British Columbia, Canada"
      ],
      "name": "Hubert Lee"
    },
    {
      "affiliations": [
        "Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Shashank Nagendra"
    },
    {
      "affiliations": [
        "Department of Neurosciences, Université de Montréal, Montreal, Quebec, Canada"
      ],
      "name": "Alexandre Y Poppe"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada"
      ],
      "name": "Célina Ducroux"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael’s Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Timothy R Lim"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael’s Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Karl Narvacan"
    },
    {
      "affiliations": [
        "Department of Surgery, Division of Neurosurgery, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada"
      ],
      "name": "Michael A Rizzuto"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael’s Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Afra Alfalahi"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Juntendo University Hospital, Bunkyo-ku, Japan"
      ],
      "name": "Hidehisa Nishi"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael’s Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Pragyan Sarma"
    },
    {
      "affiliations": [
        "Joint Department of Medical Imaging (JDMI), Division of Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Ze’ev Itsekson Hayosh"
    },
    {
      "affiliations": [
        "Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Katrina Ignacio"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France"
      ],
      "name": "William Boisseau"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, McMaster University, Toronto, Ontario, Canada"
      ],
      "name": "Eduardo Pimenta Ribeiro Pontes Almeida"
    },
    {
      "affiliations": [
        "Departments of Clinical Neurosciences, Radiology, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Mohammed A Almekhlafi"
    },
    {
      "affiliations": [
        "Department of Surgery, Division of Neurosurgery, Universite Laval Faculte de Medecine, Quebec, Quebec, Canada"
      ],
      "name": "Geneviève Milot"
    },
    {
      "affiliations": [
        "Division of Clinical Sciences, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada"
      ],
      "name": "Aviraj Deshmukh"
    },
    {
      "affiliations": [
        "Department of Surgery, Division of Neurosurgery, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada"
      ],
      "name": "Kislay Kishore"
    },
    {
      "affiliations": [
        "Department of Radiology, Queen’s University, Kingston, Ontario, Canada"
      ],
      "name": "Donatella Tampieri"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada"
      ],
      "name": "Jefffrey Z Wang"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Neurology, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Abhilekh Srivastava"
    },
    {
      "affiliations": [
        "Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada"
      ],
      "name": "Daniel Roy"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Federico Carpani"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, Royal University Hospital, Saskatoon, Saskatchewan, Canada"
      ],
      "name": "Nima Kashani"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Section of Neurology, University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Claudia Candale-Radu"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Section of Neurology, University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "Nishita Singh"
    },
    {
      "affiliations": [
        "Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada"
      ],
      "name": "Maria Bres-Bullrich"
    },
    {
      "affiliations": [
        "Department of Medicine, Queen’s University, Kingston, Ontario, Canada"
      ],
      "name": "Robert Sarmiento"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"
      ],
      "name": "Ryan T Muir"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Radiology, Divisions of Neuroradiology & Neurointervention, The Hospital for Sick Children, Toronto, Ontario, Canada"
      ],
      "name": "Carmen Parra-Fariñas"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"
      ],
      "name": "Stephanie D Reiter"
    },
    {
      "affiliations": [
        "Department of Neurosciences, Université de Montréal, Montreal, Quebec, Canada"
      ],
      "name": "Yan Deschaintre"
    },
    {
      "affiliations": [
        "Division of Clinical Sciences, Northern Ontario School of Medicine University, Sudbury, Ontario, Canada"
      ],
      "name": "Ravinder-Jeet Singh"
    },
    {
      "affiliations": [
        "Joint Department of Medical Imaging (JDMI), Division of Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Vivek Bodani"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Neurology, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Aristeidis H Katsanos"
    },
    {
      "affiliations": [
        "Joint Department of Medical Imaging (JDMI), Division of Interventional Neuroradiology, Toronto Western Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Ronit Agid"
    },
    {
      "affiliations": [
        "Department of Medicine, Division of Neurology, St Michael’s Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Atif Zafar"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael’s Hospital, Toronto, Ontario, Canada",
        "Department of Surgery, Division of Neurosurgery, St Michael’s Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Vitor M Pereira"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael’s Hospital, Toronto, Ontario, Canada",
        "Department of Surgery, Division of Neurosurgery, St Michael’s Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Julian Spears"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael’s Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Thomas R Marotta"
    },
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Pascal Djiadeu"
    },
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Sunjay Sharma"
    },
    {
      "affiliations": [
        "Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Forough Farrokhyar"
    },
    {
      "affiliations": [
        "Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael’s Hospital, Toronto, Ontario, Canada",
        "Department of Surgery, Division of Neurosurgery, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada",
        "Department of Medicine, Division of Neurology, St Michael’s Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Jose Danilo Bengzon Diestro"
    }
  ],
  "title": "Automated perfusion imaging did not improve reliability of ASPECTS or collateral score in late-window large vessel occlusion stroke",
  "uid": "c97f2759-6b07-5517-8ff6-89e5512d6430"
}