Author/Authors :
Ghandehari, Kavian Department of Neurology - School of Medicine, Mashhad University of Medical Sciences , Rezvani, Mohammad Reza Assistant Professor of Internal Medicine - School of Medicine, Birjand University of Medical Sciences , Taghi Shakeri, Mohammad Associate Professor of Biostatistics - School of Medicine, Mashhad University of Medical Sciences , Mohammadifard, Mahdi Department of Radiology - School of Medicine, Birjand University of Medical Sciences , Ehsanbakhsh, Alireza Department of Radiology - School of Medicine, Birjand University of Medical Sciences , Mohammadifard, Mahyar Department of Radiology - School of Medicine, Birjand University of Medical Sciences , Mirgholami, Alireza Department of Radiology - School of Medicine, Birjand University of Medical Sciences , Boostani, Reza Department of Neurology - Faculty of Medicine, Mashhad University of Medical Sciences , Ghandehari, Kosar Research Fellow - School of Medicine, Mashhad University of Medical Sciences , Izadi-Mood, Zahra Department of Neuroscience - School of Medicine, Mashhad University of Medical Sciences
Abstract :
BACKGROUND: The Alberta Stroke Program Early Computerized Tomography Score (ASPECTS) was used to detect
significant early ischemic changes on brain CT of acute stroke patients. We designed the modified ASPECTS and compared
it to the above system based on the inter-rater reliability.
METHODS: A cross-sectional validation study was conducted based on the inter-rater reliability. The CT images were
chosen from the stroke data bank of Ghaem hospital, Mashhad in 2010. The inclusion criteria were the presence of middle
cerebral artery territory infarction and performance of CT within 6 hours after stroke onset. Axial CT scans were
performed on a third-generation CT scanner (Siemens, ARTX, Germany). Section thickness above posterior fossa was
10 mm (130 kV, 150 mAs). Films were made at window level of 35 HU. The brain CTs were scored by four independent
radiologists based on the ASPECTS and modified ASPECTS. The readers were blind to clinical information except
symptom side. Cochrane Q and Kappa tests served for statistical analysis.
RESULTS: 24 CT scans were available and of sufficient quality. Difference in distribution of dichotomized ≤7 and >7
ASPECT scores between four raters was significant (Q=13.071, df=3, p=0.04). Distribution of dichotomized <6 and ≥6
scores based on modified ASPECT system between 4 raters was not significantly different (Q=6.349, df=3, p=0.096).
Keywords :
Computed Tomography , Cerebral Infarction , Thrombolysis , Inter-Rater Reliability
