E-ISSN 1305-3612
Neuroradiology - Original Article
Interobserver agreement between senior radiology resident, neuroradiology fellow and experienced neuroradiologist in the rating of Alberta Stroke Program Early Computed Tomography Score (ASPECTS)
1 Division of Interventional Neuroradiology, Department of Diagnostic and therapeutic Radiology, Ramathibodi Hospital, Mahidol University School of Medicine, Bangkok, Thailand  
2 Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University School of Medicine, Bangkok, Thailand  
Diagn Interv Radiol ; : -

Abstract

Purpose: The measurement of the distribution of the ischemic change of the middle cerebral artery (MCA) territories infarction is usually defined using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS). The first provider in the emergency department for interpretation of the brain CT is the on-call radiology resident. The primary objective of this study was to describe the agreement of the ASPECTS performed retrospectively by the resident compared with expert raters. The second objective was to ascertain the appropriate window setting for early detection of acute ischemic stroke and good interobserver agreement between the interpreters.

 

Methods: We identified consecutive patients presenting with hemiparesis or aphasia at the emergency department who underwent brain computed tomography (CT) and brain CT angiography. Each scan was rated for ASPECTS by senior radiology resident, neuroradiology fellow and later by consensus between two expert raters. Statistical analysis included determination of Cohen’s kappa (κ) coefficient and intraclass correlation coefficient (ICC).

 

Results: Forty-three patients met our study criteria. Interobserver agreements for ASPECTS varied from 0.486 to 0.678 in Cohen’s kappa coefficient between consensus of two neuroradiologists and a neuroradiology fellow, and from 0.198 to 0.491 for consensus between two neuroradiologists and a senior radiology resident. ICC among three raters (expert consensus, neuroradiology fellow and senior radiology resident), was very good in setting 8-HU window width and 32-HU center level.

 

 

Conclusion: ASPECTS vary among raters. However, when using a narrowed window setting for interpretation, interobserver agreement improved.

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