Evaluación de la elegibilidad de Brainomix e-ASPECTS para imágenes de ictus agudo

Timely and accurate assessment of acute ischemic stroke is crucial for determining eligibility for mechanical thrombectomy. The Alberta Stroke Program Early CT Score (ASPECTS) is a widely used tool for evaluating early ischemic changes on non-contrast CT (NCCT), but its interpretation is subject to interobserver variability. Brainomix e-ASPECTS is an automated software designed to standardize and expedite this assessment. We aimed to evaluate the clinical utility and diagnostic performance of the Brainomix e-ASPECTS software in an unselected, real-world cohort of patients undergoing NCCT for suspected acute ischemic stroke.

We retrospectively analyzed 1,029 NCCT studies from 954 patients between March 2020 and December 2024. e-ASPECTS scores were compared to radiologist-assigned ASPECTS, which served as the reference standard. Diagnostic accuracy, sensitivity, specificity, and correlation between scoring methods were assessed.

There was a strong correlation between e-ASPECTS and radiologist ASPECTS (ρ = 0.953, p < 0.001). For detecting acute ischemia, sensitivity was 95.8% (95% CI, 93.6-97.3%), specificity 96.9% (95% CI, 94.7-98.2%), and overall accuracy 96.3% (95% CI, 95.1-97.5%). The positive predictive value was 97.2% (95% CI, 95.3-98.4%), and the negative predictive value was 95.3% (95% CI, 92.8-96.9%). Score concordance was high, with exact matches in 92.3% of cases and a ≤ 1-point difference in 97.7%. Misclassification for thrombectomy eligibility (ASPECTS < 6) occurred in four cases (0.4%). The software achieved a processing success rate of 91.9%.

E-ASPECTS demonstrates high diagnostic accuracy and strong agreement with expert radiological assessment, supporting its role as a valuable decision support tool in acute stroke imaging. However, its use should complement, not replace, expert interpretation, particularly in patients with low ASPECTS scores, where treatment decisions are most sensitive.