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We evaluated automated ASPECTS in comparison to expert readers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive, baseline non-contrast CT-scans (5-mm slice thickness) from the prospective MR CLEAN trial (<jats:italic>n<\/jats:italic>= 459, MR CLEAN Netherlands Trial Registry number: NTR1804) were evaluated. A two-observer consensus for ASPECTS regions (normal\/abnormal) was used as reference standard for training and testing (0.2\/0.8 division). Two other observers provided individual ASPECTS-region scores. The Automated ASPECTS software was applied. A region score specificity of \u2265 90% was used to determine the software threshold for detection of an affected region based on relative density difference between affected and contralateral region. Sensitivity, specificity, and receiver-operating characteristic curves were calculated. Additionally, we assessed intraclass correlation coefficients (ICCs) for automated ASPECTS and observers in comparison to the reference standard in the test set.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the training set (<jats:italic>n<\/jats:italic>= 104), with software thresholds for a specificity of \u2265 90%, we found a sensitivity of 33\u201349% and an area under the curve (AUC) of 0.741\u20130.785 for detection of an affected ASPECTS region. In the test set (<jats:italic>n<\/jats:italic>= 355), the results for the found software thresholds were 89\u201389% (specificity), 41\u201357% (sensitivity), and 0.750\u20130.795 (AUC). Comparison of automated ASPECTS with the reference standard resulted in an ICC of 0.526. Comparison of observers with the reference standard resulted in an ICC of 0.383\u20130.464.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The performance of automated ASPECTS is comparable to expert readers and could support readers in the detection of early ischemic changes.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00234-020-02533-6","type":"journal-article","created":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T10:04:41Z","timestamp":1598609081000},"page":"491-498","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Validation of automated Alberta Stroke Program Early CT Score (ASPECTS) software for detection of early ischemic changes on non-contrast brain CT scans"],"prefix":"10.1007","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2448-122X","authenticated-orcid":false,"given":"Lennard","family":"Wolff","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2212-6128","authenticated-orcid":false,"given":"Olvert A.","family":"Berkhemer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6119-7247","authenticated-orcid":false,"given":"Adriaan C. 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Berkhemer: The Amsterdam UMC received funds for consultations done by OAB for Stryker Neurovascular.Adriaan C.G.M. van Es: noneWim H. van Zwam: The Maastricht UMC+ received funds for consultations done by WHZ for Cerenovus and Stryker Neurovascular.Diederik W.J. Dippel: noneCharles B.L.M. Majoie: research grants from CVON\/Dutch Heart Foundation, European Commission, TWIN foundation, Stryker, Dutch Health Evaluation program, Stryker (all paid to institution), is shareholder of Nico-lab (modest)Theo van Walsum: noneAad van der Lugt: The Erasmus MC received grants for research from Siemens Healthineers, GE Healthcare and Philips Healthcare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The MR CLEAN study protocol was approved by a central medical ethics committee and the research board of each participating center.All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.For this type of study formal consent is not required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"All patients or their legal representatives provided written informed consent before randomization in this study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}