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

IF 2.3 4区医学 Q3 CLINICAL NEUROLOGY Journal of Neuroimaging Pub Date : 2024-01-07 DOI:10.1111/jon.13184

Armin Zarrintan, Mohamed K. Ibrahim, Noha Hamouda, Mohamed Sobhi Jabal, Zahra Beizavi, Sherief Ghozy, David F. Kallmes

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Abstract

Background and Purpose

The Alberta Stroke Program Early CT Score (ASPECTS) is a widely used scoring system for evaluating ischemic stroke to determine therapeutic strategy. However, there is variation in the interobserver agreement of ASPECTS. This systematic review and meta-analysis aimed to investigate the interobserver agreement of total and regional ASPECTS.

Methods

A comprehensive search was conducted in the Web of Sciences, PubMed, and Scopus databases to identify relevant studies. Inclusion criteria were studies of noncontrast CT performed within 24 hours of ischemic stroke in the middle cerebral artery territory.

Results

A total of 20 studies, with 3482 patients, reporting interobserver agreement of total and regional ASPECTS were included in the meta-analysis. The interobserver agreement for total ASPECTS in studies using Kappa coefficient (κ) analysis was substantial (κ = .67, 95% confidence interval [CI]: .57-.78). In studies using intraclass correlation coefficient (ICC) analysis, agreement was excellent (ICC = .84, 95% CI: .77-.90). Interobserver agreement was higher in studies in which the observer was unblinded to clinical scenario in both groups (κ = .74, 95% CI: .59-.89, and ICC = .82, 95% CI: .79-.85). Per-region analysis showed that the caudate nucleus had the highest agreement (κ = .68, 95% CI: .60-.76, and ICC = .84, 95% CI: .74-.93), while M2 and internal capsule in Kappa studies (κ = .45, 95% CI: .34-.55 and κ = .47, 95% CI: .28-.66), and M4 and internal capsule in ICC studies (ICC = .54, 95% CI: .43-.64 and ICC = .55, 95% CI: .18-.91) had the lowest agreement.

Conclusion

This meta-analysis demonstrates substantial to excellent interobserver agreement for total ASPECTS, which supports using this method for stroke treatment. However, findings emphasize the need to consider interobserver agreement in specific regions of ASPECTS for treatment decisions.

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阿尔伯塔省卒中计划早期计算机断层扫描评分的地区性观察者间一致性：荟萃分析

背景和目的：阿尔伯塔省卒中项目早期 CT 评分（ASPECTS）是一种广泛使用的评分系统，用于评估缺血性卒中以确定治疗策略。然而，ASPECTS 的观察者间一致性存在差异。本系统综述和荟萃分析旨在研究总ASPECTS和区域ASPECTS的观察者间一致性：在 Web of Sciences、PubMed 和 Scopus 数据库中进行了全面检索，以确定相关研究。纳入标准为大脑中动脉区域缺血性卒中后 24 小时内进行的非对比 CT 研究：荟萃分析共纳入了 20 项研究，涉及 3482 名患者，报告了总 ASPECTS 和区域 ASPECTS 的观察者间一致性。在使用卡帕系数（κ）分析的研究中，总ASPECTS的观察者间一致性很高（κ = .67，95%置信区间[CI]：.57-.78）。在使用类内相关系数 (ICC) 分析的研究中，一致性非常好（ICC = .84，95% 置信区间 [CI]：.77-.90）。在观察者对两组临床情况均不盲目的研究中，观察者之间的一致性更高（κ = .74，95% CI：.59-.89；ICC = .82，95% CI：.79-.85）。各区域分析显示，尾状核的一致性最高（κ = .68，95% CI：.60-.76；ICC = .84，95% CI：.74-.93），而 M2 和内囊的 Kappa 研究（κ = .45，95% CI：.34-.55 和 κ = .47，95% CI：.28-.66），而 ICC 研究中 M4 和内囊（ICC = .54，95% CI：.43-.64 和 ICC = .55，95% CI：.18-.91）的一致性最低：这项荟萃分析表明，总 ASPECTS 的观察者间一致性非常高，甚至达到了极佳的水平，这支持将此方法用于卒中治疗。然而，研究结果强调，治疗决策需要考虑 ASPECTS 特定区域的观察者间一致性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neuroimaging 医学-核医学

CiteScore

4.70

自引率

0.00%

发文量

117

审稿时长

6-12 weeks

期刊介绍： Start reading the Journal of Neuroimaging to learn the latest neurological imaging techniques. The peer-reviewed research is written in a practical clinical context, giving you the information you need on: MRI CT Carotid Ultrasound and TCD SPECT PET Endovascular Surgical Neuroradiology Functional MRI Xenon CT and other new and upcoming neuroscientific modalities.The Journal of Neuroimaging addresses the full spectrum of human nervous system disease, including stroke, neoplasia, degenerating and demyelinating disease, epilepsy, tumors, lesions, infectious disease, cerebral vascular arterial diseases, toxic-metabolic disease, psychoses, dementias, heredo-familial disease, and trauma.Offering original research, review articles, case reports, neuroimaging CPCs, and evaluations of instruments and technology relevant to the nervous system, the Journal of Neuroimaging focuses on useful clinical developments and applications, tested techniques and interpretations, patient care, diagnostics, and therapeutics. Start reading today!