Automated ASPECT Scoring

Enabling Faster Clinical Decisions for Better Patient Outcomes

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ASPECTS

What is ASPECTS

The Alberta Stroke Program Early CT Score (ASPECTS) is a 10-point quantitative score used to assess early ischemic changes on non-contrast CT (NCCT) head.

ASPECTS identifies early ischemic changes in patients suspected of acute large vessel occlusion and can be used as part of the assessment for eligibility in receiving mechanical thrombectomy treatment.

Why use ASPECTS

ASPECTS is Class of Recommendation I (COR-I) and Level of Evidence B-NR (LOE B-NR) supported by AHS/ASA Stroke Guidelines and Canadian Stroke Guidelines.
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Easily Applicable

The ASPECT Score can be used to assess early ischemic changes in acute stroke on any modern CT scanner without the need for additional processing steps making it easily applicable in many settings worldwide
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Imaging Based

As the initial imaging modality to both screen for and establish the diagnosis of acute stroke, the ASPECT Score provides an opportunity to quantify the degree of ischemic changes in the brain parenchyma and serve as the basis for subsequent decision making.
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Easily Communicated

A score out of 10, the ASPECT Score is an easy and widely understood means of communicating the extent of ischemic changes amongst care teams and physicians.
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Backed by Research

Cited in stroke journals and publications as the standardized means of communication of early ischemic changes, the ASPECTS is used in a multitude of articles and scientific journals.

How To Use ASPECTS When Assessing Stroke Patient Treatment

Calculating ASPECTS

  • 1 point is subtracted from 10 for evidence of early ischemic change for each of the defined regions.
  • A normal CT scan receives an ASPECTS of 10 points.
  • An ASPECTS of 0 indicates diffuse involvement throughout the MCA territory

What do ASPECT Scores mean

ASPECTS values are indirectly related to core size:
  •  ASPECTS =   CORE
  •  ASPECTS =   CORE
  • ASPECTS scores 6-10 = Thrombectomy candidates
  • ASPECTS scores 0-5 = Poor thrombectomy candidates
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Source: http://www.aspectsinstroke.com

ASPECTS and American Heart Association Guidelines on the Management of Acute Stroke

American Heart Association Guidelines: ASPECTS must be greater than or equal 6 within 6 hrs for patient eligibility for mechanical thrombectomy
NIHSS
> 6
ASPECTS
> 6
Stroke Onset
Within 6 Hours
Patient Eligible Mechanical Thrombectomy
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Why Automate ASPECTS

  • It provides standardized results for predictive assessment of patient eligibility for thrombectomy, removing variability associated with individual clinician interpretation
  • It enables physicians to quickly identify early ischemic changes on non-contrast CT (NCCT) scans—helping stroke teams make faster triage-or-transfer decisions
  • It ensures that all patients receive equivalent care and are triaged with appropriate treatment options
Rapid ASPECTS

Automatic Identification of ASPECTS Regions and Scores

  • Rapid ASPECTS is the only neuroimaging product shown to improve physicians’ interpretations of Non-Contrast CT (NCCT) scans using a standardized ASPECT score
  • Rapid ASPECTS is the first-ever neuroimaging solution to receive clearance from the FDA in the CADx (Computer-Assisted Diagnostic software) category
  • Validated through the rigorous FDA process, the use of Rapid ASPECTS automated score, combined with the physician’s review of the scan, improves the accuracy of the ASPECT score calculation which is important for less experienced readers
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Rapid ASPECTS How it Works

Based on the Alberta Stroke Program Early CT Scoring (ASPECTS) system, Rapid ASPECTS uses a validated machine-learning algorithm to automatically identify the ASPECTS regions of the brain and generate an ASPECT score to indicate early signs of brain infarction on NCCT scans—helping physicians identify areas of irreversible brain injury.

Workflow

Rapid ASPECTS Workflow

  • NCCT acquired
  • NCCT image data is sent to the ICH module
  • The ICH module automatically processes images and identifies the presence (or absence) of a suspected intracranial hemorrhage (ICH). If a suspected intracranial hemorrhage is identified, the workflow ends. The results are not analyzed to determine an ASPECT score
    • A) Rapid ASPECTS FDA Indications for use are for patients within 6 hours symptom onset with LVO stroke.
  • If the NCCT scan doesn’t show a presence of a suspected ICH the image data is sent to the ASPECTS module.
  • The ASPECTS module automatically processes images and assesses them for subtle ischemic changes.
  • Rapid ASPECTS delivers results via the web portal, email, and the RapidAI mobile app.
  • At the discretion of the clinician, the scores may be adjusted based on the clinician’s judgment as well as other factors the clinician may integrate though the web portal.
  • When it has been confirmed that the patient has an LVO in the web portal, the results are sent to PACS .

Rapid ASPECTS
Key Benefits

Faster Clinical Decisions for Better Patient Outcomes

  • ASPECTS automatically delivers a standardized ASPECTS score to enable a physician to quickly identify areas of irreversible injury.

  • The use of Rapid ASPECTS automated score, combined with the physician’s review of the scan, improves the accuracy of ASPECT score calculation which is important for less experienced readers.

  • Within minutes of receipt of an NCCT scan, Rapid ASPECTS delivers results via PACS, email, and the RapidAI mobile app to help stroke teams make faster clinical decisions for patients with large vessel occlusions (LVOs)—helping to facilitate better patient outcomes.

Rapid ASPECTS
Rapid ASPECTS Clinically Validated To Address These Challenges

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Human ASPECTS Score interpretation is subject to interobserver reliability and can substantially affect the decision-making process, resulting in erroneous inclusion or exclusion of patients for thrombectomy

Standardized Rapid ASPECTS results increase reader reliability and reduce intra-reader variability — especially among spoke facility readers

Clinical Validation

1. Research Finding

A clinical study performed in Germany demonstrated that when the Alberta Stroke Program Early CT score was calculated with Rapid ASPECTS there was better reader agreement than that of expert human readers with a predefined consensus score.1

  • a) Two experienced neuroradiologists showed moderate reader agreement with a predefined ASPECTS consensus score (k = 0.57 and k = 0.56).
  • b) When Rapid ASPECTS was used to calculate an ASPECT score, there was substantial reader agreement (k = 0.90) with the predefined consensus score ASPECTS evaluation.1

Source: 1 Maegerlein MD, Christian, Fischer MD, Johanna, Sebastian MD, Mönch, et al., Automated Calculation of the Alberta Stroke Program Early CT Score: Feasibility and Reliability. Radiology 2019; 291:141–148. /doi.org/10.1148/radiol.2019181228

2. Research Finding

A clinical study showed that Rapid ASPECTS had excellent agreement (κ = 0.80) with expert readers and that there was a significantly (P < 0.001) increased odds of functional independence and fewer hemorrhagic complications when treatment decisions were made in conjunction with the automated ASPECTS score.2
  • a) This study also found that automated ASPECTS might predict outcomes after IV thrombolysis.2

Source: 2 Mansour, Ossama, Ramadan, Ismail, Abdo, Ashraf, et al. Deciding Thrombolysis in AIS Based On Automated versus on WhatsApp Interpreted ASPECTS, a Reliability and Cost-Effectiveness Analysis in Developing System of Care. Front. Neurol. 2020; 11 (33): doi:10.3389/fneur.2020.00333

3. Research Finding

In an analysis of data from the GAMES-RP study, Rapid ASPECTS demonstrated that Rapid ASPECTS was more accurate than experienced clinicians in identifying early evidence of brain ischemia as documented by DWI.3


Source: 3 Albers, Gregory W., Wald, Michael J., Mlynash, Michael et al. Automated Calculation of Alberta Stroke Program Early CT Score Validation in Patients With Large Hemispheric Infarct. Stroke, 2019;50:3277–3279. doi:10.1161/STROKEAHA.119.026430

Slow manual assessments miss the critical 6-to-24-hour window for evaluation

Rapid ASPECTS enables faster triage and transfer decisions that facilitate better patient outcomes

Clinical Validation

1. Research Finding

A clinical study showed that by automating and standardizing this process, Rapid ASPECTS helps stroke teams across hospital sites and referral networks quickly assess patient eligibility for thrombectomy—enabling faster triage and transfer decisions that facilitate better patient outcomes.2

  • a) A 14-min reduction in the DTN time was observed in the group of AIS patients with automated ASPECTS interpretation (median of 50 and 36min in group 1 and group 2, respectively).2

Source:2  Mansour, Ossama, Ramadan, Ismail, Abdo, Ashraf, et al. Deciding Thrombolysis in AIS Based On Automated versus on WhatsApp Interpreted ASPECTS, a Reliability and Cost-Effectiveness Analysis in Developing System of Care. Front. Neurol. 2020; 11 (33): doi:10.3389/fneur.2020.00333

Automated ASPECTS software is more expensive than human ASPECTS interpretation

Rapid ASPECTS provides reliable and cost-effective results

Clinical Validation

1. Research Finding

A clinical study showed that:
  • a) Automated identification of ASPECTS regions and scores by Rapid ASPECTS was found to be equally reliable as interpretation by expert neuroradiologist
  • b) The interpretation by neuroradiologists was severely degraded when CT images were viewed via WhatsApp Messenger.
  • c) A cost-effectiveness analysis based on the ICER framework revealed that interpreting images sent via WhatsApp—while less expensive—is ultimately more costly than automatic interpretation by Rapid ASPECTS due to prolonged stay from complications and death. 2

Source:2 Mansour, Ossama, Ramadan, Ismail, Abdo, Ashraf, et al. Deciding Thrombolysis in AIS Based On Automated versus on WhatsApp Interpreted ASPECTS, a Reliability and Cost-Effectiveness Analysis in Developing System of Care. Front. Neurol. 2020; 11 (33): doi:10.3389/fneur.2020.00333

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