Can we Rely on Smartphone to Evaluate Acute İschemic Strokes? A Diagnostic Accuracy Study

Acute ischemic stroke requires rapid diagnosis and treatment for better clinical outcomes. In the emergency department, consultation via smartphone can be used to quickly confirm the radiological diagnosis.

The aim of this study was to evaluate the diagnostic reliablity of diffusion-weighted magnetic resonance imaging (DWI) images evaluated via smartphone in detecting acute ischemic lesions.

One hundred and ten patients who underwent diffusion DWI examination with a preliminary diagnosis of ischemic stroke in the emergency department were included. Patients' images were sent by the neurologist via WhatsApp to the two radiologists and evaluated blindly. These images were also evaluated by two radiologists using the web-based mobile software of a DICOM imaging application. Evaluated areas were classified into five sections as large vessel territory, lacunar infarct, hemorrhage, chronic sequelae changes, and normal.

Excellent and good concordance was observed between observers for four abnormal classified sections. In the normal classified group, moderate and low level of concordance was found between the participants (Kappa = 0.353, P < 0.001). In the evaluation of lacunar infarcts, the sensitivity of smartphones was found to be low. In addition, it was observed that the specificity of the cases evaluated as normal on smartphones was low, being more evident in the videos sent from WhatsApp.

In order to shorten the diagnosis time of ischemic stroke, clinicians may be requested to evaluate it with smartphones. However, to our findings, we suggest that mobile imaging techniques cannot take the role of medical monitors and that cases assessed using a mobile device should be verified using a monitor.