Diagnostic performance of an algorithm for automated collateral scoring on computed tomography angiography

Lennard Wolff*, Simone M. Uniken Venema, MR CLEAN Registry Investigators, Sven P.R. Luijten, Jeannette Hofmeijer, Jasper M. Martens, Marie Louise E. Bernsen, Adriaan C.G.M. van Es, Pieter Jan van Doormaal, Diederik W.J. Dippel, Wim van Zwam, Theo van Walsum, Aad van der Lugt

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objectives: Outcome of endovascular treatment in acute ischemic stroke patients depends on collateral circulation to provide blood supply to the ischemic territory. We evaluated the performance of a commercially available algorithm for assessing the collateral score (CS) in acute ischemic stroke patients. Methods: Retrospectively, baseline CTA scans (≤ 3-mm slice thickness) with an intracranial carotid artery (ICA), middle cerebral artery segment M1 or M2 occlusion, from the MR CLEAN Registry (n = 1627) were evaluated. All CTA scans were evaluated for visual CS (0–3) by eight expert radiologists (reference standard). A Web-based AI algorithm quantified the collateral circulation (0–100%) for correctly detected occlusion sides. Agreement between visual CS and categorized automated CS (0: 0%, 1: > 0– ≤ 50%, 2: > 50– < 100%, 3: 100%) was assessed. Area under the curve (AUC) values for classifying patients in having good (CS: 2–3) versus poor (CS: 0–1) collaterals and for predicting functional independence (90-day modified Rankin Scale 0–2) were computed. Influence of CTA acquisition timing after contrast material administration was reported. Results: In the analyzed scans (n = 1024), 59% agreement was found between visual CS and automated CS. An AUC of 0.87 (95% CI: 0.85–0.90) was found for discriminating good versus poor CS. Timing of CTA acquisition did not influence discriminatory performance. AUC for predicting functional independence was 0.66 (95% CI 0.62–0.69) for automated CS, similar to visual CS 0.64 (95% CI 0.61–0.68). Conclusions: The automated CS performs similar to radiologists in determining a good versus poor collateral score and predicting functional independence in acute ischemic stroke patients with a large vessel occlusion. Key Points: • Software for automated quantification of intracerebral collateral circulation on computed tomography angiography performs similar to expert radiologists in determining a good versus poor collateral score. • Software for automated quantification of intracerebral collateral circulation on computed tomography angiography performs similar to expert radiologists in predicting functional independence in acute ischemic stroke patients with a large vessel occlusion. • The timing of computed tomography angiography acquisition after contrast material administration did not influence the performance of automated quantification of the collateral status.

Original languageEnglish
Pages (from-to)5711-5718
Number of pages8
JournalEuropean Radiology
Volume32
Issue number8
DOIs
Publication statusPublished - Aug 2022

Bibliographical note

Funding
MR CLEAN Registry has received funding by stichting Toegepast Wetenschappelijk Instituut voor Neuromodulatie (TWIN) and institutional funds: Amsterdam UMC, Erasmus MC, MUMC+.

The current study is executed within the CONTRAST consortium. The CONTRAST consortium is supported by Netherlands Cardiovascular Research Initiative, an initiative of the Dutch Heart Foundation, by the Brain Foundation Netherlands and powered by Health~Holland, Top Sector Life Sciences and receives unrestricted funding from Stryker, Penumbra, Medtronic and Cerenovus.

Publisher Copyright: © 2022, The Author(s).

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