Real- world evaluation of Brainomix e- Stroke software

Background and purpose Brainomix e-Stroke is an artificial intelligence-based decision support tool that aids the interpretation of CT imaging in the context of acute stroke.While e-Stroke has the potential to improve the speed and accuracy of diagnosis,real-world validation is essential.The aim of this study was to prospectively evaluate the performance of Brainomix e-Stroke in an unselected cohort of patients with suspected acute ischaemic stroke.Methods The study cohort included all patients admitted to the University College London Hospital Hyperacute Stroke Unit between October 2021 and April 2022.For e-ASPECTS and e-CTA,the ground truth was determined by a neuroradiologist with access to all clinical and imaging data.For e-CTP,the values of the core infarct and ischaemic penumbra were compared with those derived from syngo.via,an alternate software used at our institution.Results 1163 studies were performed in 551 patients admitted during the study period.Of these,1130(97.2%)were successfully processed by e-Stroke in an average of 4min.For identifying acute middle cerebral artery territory ischaemia,e-ASPECTS had an accuracy of 77.0%and was more specific(83.5%)than sensitive(58.6%).The accuracy for identifying hyperdense thrombus was lower(69.1%),which was mainly due to many false positives(positive predictive value of 22.9%).Identification of acute haemorrhage was highly accurate(97.8%)with a sensitivity of 100%and a specificity of 97.6%;false positives were typically caused by areas of calcification.The accuracy of e-CTA for large vessel occlusions was 91.5%.The core infarct and ischaemic penumbra volumes provided by e-CTP strongly correlated with those provided by syngo.via(ρ=0.804—0.979).Conclusion Brainomix e-Stroke software provides rapid and reliable analysis of CT imaging in the acute stroke setting although,in line with the manufacturer’s guidance,it should be used as an adjunct to expert interpretation rather than a standalone decision-making tool.

Cerebral microhaemorrhage in COVID-19: a critical illness related phenomenon?

Background Cerebral microhaemorrhages are increasingly being recognised as a complication of COVID-19.This observational retrospective study aims to further investigate the potential pathophysiology through assessing the pattern of microhaemorrhage and clinical characteristics of patients with COVID-19 and microhaemorrhage.By comparing with similar patterns of microhaemorrhage in other non-COVID-19 disease,this study aims to propose possible common pathogenic mechanisms.Methods A retrospective observational case series was performed identifying all patients with COVID-19 complicated by cerebral microhaemorrhage on MRI.The distribution and number of microhaemorrhages were recorded using the microbleed anatomical scale,and patients’baseline characteristics and salient test results were also recorded.Results Cerebral microhaemorrhages were noted to have a predilection for the corpus callosum,the juxtacortical white matter and brainstem.All patients had a preceding period of critical illness with respiratory failure and severe hypoxia necessitating intubation and mechanical ventilation.Discussion This study demonstrates a pattern of cerebral microhaemorrhage that is similar to the pattern reported in patients with non-COVID-19 related critical illness and other causes of severe hypoxia.This raises questions regarding whether microhaemorrhage occurs from endothelial dysfunction due the direct effect of SARS-CoV-2 infection or from the secondary effects of critical illness and hypoxia.