Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 16, 2019
Date Accepted: Mar 23, 2020
Reliability of Assessment of Neuroimaging by Smartphone for Diffusion Weighted Imaging–Alberta Stroke Program Early Computed Tomography Scores in Acute Ischemic Stroke Patients
ABSTRACT
Background:
High-quality neuroimages can be viewed via a medical app installed on a smartphone. Although inter-device agreement between smartphone and desktop PC monitor was found to be favorable for evaluating CT images, there are no inter-device agreement data for DWI.
Objective:
Our objective is to investigate the diagnostic accuracy and interrater agreement of Diffusion-weighted Imaging–Alberta Stroke Program Early Computed Tomography Scores (DWI-ASPECTS) in acute ischemic stroke patients for neuroimages evaluated on a smartphone app and on a desktop PC monitor.
Methods:
The ischemic change in the DWI of consecutive patients with acute stroke in the MCA territory was graded by two vascular neurologists via a JOIN smartphone app and a desktop PC monitor. The vascular neurologists were blinded to all patient information. Each image was categorized as either DWI-ASPECTS ≥7 or DWI-ASPECTS <7 according to the Japan Society for Neuroendovascular Therapy. We analyzed inter-device agreement and inter-rater agreement with respect to DWI-ASPECTS. Elapsed interpretation time was compared between DWI-ASPECTS evaluated by JOIN smartphone app and that by desktop PC monitor.
Results:
We analyzed the images of 111 patients (66% male, median age, 69 years; median NIHSS score on admission, 4). Inter-device agreement regarding DWI-ASPECTS between the smartphone and the desktop PC monitor was favorable agreement (vascular neurologist 1; kappa = 0.777, p<0.001, vascular neurologist 2; kappa = 0.787, p < 0.001). Inter-rater agreement was also satisfactory for the smartphone (kappa = 0.710, p < 0.001), and the desktop PC monitor (kappa = 0.663, p < 0.001). Median elapsed interpretation time was similar between the smartphone and the desktop PC monitor (vascular neurologist 1, 1.7 vs. 1.6 min (p = 0.64); and vascular neurologist 2, 2.4 vs. 2.0 min (p = 0.14).
Conclusions:
The use of a smartphone app enables vascular neurologists to estimate DWI-ASPECTS accurately and rapidly. The JOIN medical smartphone app shows great promise in the management of acute stroke.
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