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ASPECTS Distorts Infarct Volume Measurement

ASPECTS Distorts Infarct Volume Measurement LETTERS undaram et al reported lucidly on agreements and correla- Besides the well-documented ABC/2 and 2Sh/3, the software Stions of ASPECTS for NCCT (manual, automatic) and CTP- behind any auto-ASPECTS can, in principle, report infarct vol- CBV (manual). But why use ASPECTS, not volume? umes. If these and other authors skip ASPECTS and use volume, Invented as a volume surrogate, ASPECTS takes the form of their agreements and correlations might be stronger and their “content analysis”—a research method to quantify texts and sym- plots less scattered. bols, wherein ASPECTS unitizes the MCA territory by defining Disclosures: Marco C. Pinho—UNRELATED: Consultancy: ABC Medical Education, 10 regions and categorizes each unit as having either no or any Comments: On-line educational activities related to MRI. acute infarction. Measurement is degraded by the unitization’s vague definitions and diverse volumes, the binary categorization REFERENCES of so few units, and the bias of “any.” ASPECTS promotes inter- 1. Sundaram VK, Goldstein J, Wheelwright D, et al. Automated ASPECTS in acute ischemic stroke: a comparative analysis with CT observer disagreement (masked by “auto-”) and scatters mark- perfusion. AJNR Am J Neuroradiol 2019;40:2033–38 CrossRef Medline edly away from true volume. It is not excused for individual 2. Krippendorff K. Content Analysis: An Introduction to its Methodology, patient use by mere population correlation. Moreover, ASPECTS 4th ed. Los Angeles: Sage Publications; 2019 tends to advance infarcts by sometimes large margins of error 3. Suss RA. ASPECTS, the mismeasure of stroke: a metrological beyond a supposed threshold of risk or futility, denying throm- investigation. OSF Preprints 2019 https://doi.org/10.31219/osf.io/ bectomy. A detailed explanation of ASPECTS and its flaws and a c4tkp. Accessed December 31, 2019 quick remediation by manual volumetry using the diameter for- R.A. Suss mula ABC/2 (or a PACS-friendly refinement called 2Sh/3) are M.C. Pinho available. Department of Radiology University of Texas Southwestern Medical Center http://dx.doi.org/10.3174/ajnr.A6485 Dallas, Texas E28 Letters May 2020 www.ajnr.org http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

ASPECTS Distorts Infarct Volume Measurement

American Journal of Neuroradiology , Volume 41 (5) – May 1, 2020

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Publisher
American Journal of Neuroradiology
Copyright
© 2020 by American Journal of Neuroradiology
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A6485
Publisher site
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Abstract

LETTERS undaram et al reported lucidly on agreements and correla- Besides the well-documented ABC/2 and 2Sh/3, the software Stions of ASPECTS for NCCT (manual, automatic) and CTP- behind any auto-ASPECTS can, in principle, report infarct vol- CBV (manual). But why use ASPECTS, not volume? umes. If these and other authors skip ASPECTS and use volume, Invented as a volume surrogate, ASPECTS takes the form of their agreements and correlations might be stronger and their “content analysis”—a research method to quantify texts and sym- plots less scattered. bols, wherein ASPECTS unitizes the MCA territory by defining Disclosures: Marco C. Pinho—UNRELATED: Consultancy: ABC Medical Education, 10 regions and categorizes each unit as having either no or any Comments: On-line educational activities related to MRI. acute infarction. Measurement is degraded by the unitization’s vague definitions and diverse volumes, the binary categorization REFERENCES of so few units, and the bias of “any.” ASPECTS promotes inter- 1. Sundaram VK, Goldstein J, Wheelwright D, et al. Automated ASPECTS in acute ischemic stroke: a comparative analysis with CT observer disagreement (masked by “auto-”) and scatters mark- perfusion. AJNR Am J Neuroradiol 2019;40:2033–38 CrossRef Medline edly away from true volume. It is not excused for individual 2. Krippendorff K. Content Analysis: An Introduction to its Methodology, patient use by mere population correlation. Moreover, ASPECTS 4th ed. Los Angeles: Sage Publications; 2019 tends to advance infarcts by sometimes large margins of error 3. Suss RA. ASPECTS, the mismeasure of stroke: a metrological beyond a supposed threshold of risk or futility, denying throm- investigation. OSF Preprints 2019 https://doi.org/10.31219/osf.io/ bectomy. A detailed explanation of ASPECTS and its flaws and a c4tkp. Accessed December 31, 2019 quick remediation by manual volumetry using the diameter for- R.A. Suss mula ABC/2 (or a PACS-friendly refinement called 2Sh/3) are M.C. Pinho available. Department of Radiology University of Texas Southwestern Medical Center http://dx.doi.org/10.3174/ajnr.A6485 Dallas, Texas E28 Letters May 2020 www.ajnr.org

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: May 1, 2020

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