Abstract

PurposeSoftware solutions such as mRay allow review of radiological images on handheld devices. We investigated if the quality is adequate for evaluating CT scans of patients with suspected stroke.Methods50 patients (Median age 80 years, 28 females) were retrospectively selected. All patients had undergone multidetector CT angiography ± perfusion and presented with clinical signs of acute stroke. Out of the 50 patients, 19 had large-vessel occlusion (LVO), 5 had intracranial hemorrhage (ICH), 10 had severe intracranial stenosis of at least one major vessel, 2 had intracranial tumor and 15 had no or an unrelated pathology. One experienced neuroradiologist and one resident scored the anonymized pictures separately on two handheld devices (iPhone 7 Plus, MED-TAB) equipped with mRay Software and on a PACS workstation. Each case was reviewed on all three devices with a break in-between of at least 12 weeks. The scoring on the traditional workstation was compared with the two handheld devices, regarding detection of early ischemic signs, LVOs, CBV/CBF-mismatch, ICHs and severe stenosis. Both raters were asked to rate the diagnostic quality of both handheld devices regarding detection of LVOs, ICHs, early ischemic signs and overall.ResultsAll LVOs, intracranial tumors and ICHs were detected on both mobile devices. There was no significant difference in the rating of CCT and CBF ASPECTS between all three devices, while the sensitivity for detecting a CBF/CBV-mismatch was above 80% on both devices. Both raters assessed the diagnostic quality to be sufficient on both mobile devices to base treatment decisions on.ConclusionSoftware solutions such as mRay for handheld devices provide adequate diagnostic quality for the review of CT scans of suspected stroke patients.

Highlights

  • Since the first digital picture archival and communication system (PACS) has been introduced in 1995, the gold-standard for reviewing diagnostic images moved from film to computerbased display workstations.[1]

  • There was no significant difference in the rating of CCT and Cerebral blood flow (CBF) Alberta stroke program early CT score (ASPECTS) between all three devices, while the sensitivity for detecting a CBF/CBV-mismatch was above 80% on both devices

  • Overall the senior rated the two mobile devices and GE PACS to be sufficient for a diagnosis in all cases, while he rated the MED-TAB to be of perfect diagnostic value in 68%, the iPhone 7 plus in 66% and the GE PACS in 76% of the cases

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Summary

Methods

50 patients (Median age 80 years, 28 females) were retrospectively selected. All patients had undergone multidetector CT angiography ± perfusion and presented with clinical signs of acute stroke. The scoring on the traditional workstation was compared with the two handheld devices, regarding detection of early ischemic signs, LVOs, CBV/CBF-mismatch, ICHs and severe stenosis. There was no significant difference in the rating of CCT and CBF ASPECTS between all three devices, while the sensitivity for detecting a CBF/CBV-mismatch was above 80% on both devices Both raters assessed the diagnostic quality to be sufficient on both mobile devices to base treatment decisions on. CBV, Cerebral blood volume; CTA, Computer tomography angiography; CTP, Computer tomography perfusion; DICOM, Digital imaging and communications in medicine; ICH, Intracranial hemorrhage; IV-tPA, Intravenous tissue plasminogen activator; LVO, Large vessel occlusion; MDCT, Multidetector computer tomography; NASCET, North American Symptomatik Carotid Endarterectomy Trial; PACS, Picture archival and communication system

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