Region-specific interobserver agreement of the Alberta Stroke Program Early Computed Tomography Score: A...

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• The Alberta Stroke Program Early CT Score (ASPECTS) is crucial for ischemic stroke evaluation and treatment planning.
• Interobserver variability in ASPECTS scoring can impact clinical decision-making.

Purpose of the Study:

• To systematically review and meta-analyze the interobserver agreement of total and regional ASPECTS.
• To assess the reliability of ASPECTS in ischemic stroke assessment.

Main Methods:

• A comprehensive literature search was performed across Web of Science, PubMed, and Scopus.
• Included studies involved noncontrast CT within 24 hours of ischemic stroke in the middle cerebral artery territory.
• Meta-analysis was conducted on data from 20 studies involving 3482 patients.

Main Results:

• Substantial to excellent interobserver agreement was found for total ASPECTS (Kappa=.67, ICC=.84).
• Agreement was higher when observers were unblinded to clinical information.
• Regional analysis revealed highest agreement for the caudate nucleus and lowest for M2 and internal capsule.

Conclusions:

• Total ASPECTS demonstrates reliable interobserver agreement, supporting its clinical utility in stroke management.
• Variability in regional ASPECTS agreement necessitates careful interpretation for treatment decisions.
• Further standardization may be needed for specific ASPECTS regions to improve consistency.