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Journal of Medical Imaging • Open Access

Automated brain computed tomographic densitometry of early ischemic changes in acute stroke
Author(s): Berend C. Stoel; Henk A. Marquering; Marius Staring; Ludo F. Beenen; Cornelis H. Slump; Yvo B. Roos; Charles B. Majoie

Paper Abstract

The Alberta Stroke Program Early CT score (ASPECTS) scoring method is frequently used for quantifying early ischemic changes (EICs) in patients with acute ischemic stroke in clinical studies. Varying interobserver agreement has been reported, however, with limited agreement. Therefore, our goal was to develop and evaluate an automated brain densitometric method. It divides CT scans of the brain into ASPECTS regions using atlas-based segmentation. EICs are quantified by comparing the brain density between contralateral sides. This met hod was optimized and validated using CT data from 10 and 63 patients, respectively. The automated method was validated against manual ASPECTS, stroke severity at baseline and clinical outcome after 7 to 10 days (NIH Stroke Scale, NIHSS) and 3 months (modified Rankin Scale). Manual and automated ASPECTS showed similar and statistically significant correlations with baseline NIHSS (R=−0.399 and −0.277, respectively) and with follow-up mRS (R=−0.256 and −0.272), except for the follow-up NIHSS. Agreement between automated and consensus ASPECTS reading was similar to the interobserver agreement of manual ASPECTS (differences <1 point in 73% of cases). The automated ASPECTS method could, therefore, be used as a supplementary tool to assist manual scoring.

Paper Details

Date Published: 24 March 2015
PDF: 11 pages
J. Med. Img. 2(1) 014004 doi: 10.1117/1.JMI.2.1.014004
Published in: Journal of Medical Imaging Volume 2, Issue 1
Show Author Affiliations
Berend C. Stoel, Leiden Univ. Medical Ctr. (The Netherlands)
Henk A. Marquering, Academisch Medisch Centrum (Netherlands)
Marius Staring, Leiden Univ. Medical Ctr. (The Netherlands)
Ludo F. Beenen, Academisch Medisch Centrum (The Netherlands)
Cornelis H. Slump, Univ. Twente (The Netherlands)
Yvo B. Roos, Academisch Medisch Centrum (The Netherlands)
Charles B. Majoie, Academisch Medisch Centrum (The Netherlands)


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