ABSTRACT
Background: Noncontrast CT (NCCT) is used to evaluate for intracerebral hemorrhage (ICH) and ischemia in acute ischemic stroke (AIS). Large vessel occlusions (LVOs) are a major cause of AIS, but challenging to detect on NCCT. Aims: The purpose of this study is to evaluate an AI software called RAPID NCCT Stroke (RAPID, iSchemaView, Menlo Park, CA) for ICH and LVO detection compared to expert readers. Methods: In this IRB approved retrospective, multicenter study, stand-alone performance of the software was assessed based on the consensus of 3 neuroradiologists and sensitivity and specificity were determined. The platform's performance was then compared to interpretation by readers comprised of eight general radiologists (GR) and three neuroradiologists (NR) in detecting ICH and hyperdense vessel sign (HVS) indicating LVO. Results: A total of 244 cases were included. Of the 244, 115 were LVOs and 26 were ICHs. One hundred three cases did not have LVO nor ICH. Stand-alone performance of the software demonstrated sensitivities and specificities of 96.2 and 99.5% for ICH and 63.5 and 95.1% for LVO detection. Compared to all 11 readers and eight GR readers only respectively, the software demonstrated superiority, achieving significantly higher sensitivities (63.5% versus 43.6%, p < 0.0001 and 63.5% versus 40.9%, p = 0.001). Conclusion: The RAPID NCCT Stroke platform demonstrates superior performance to radiologists for detecting LVO from a NCCT. Use of this software platform could lead to earlier LVO detection and expedited transfer of these patients to a thrombectomy capable center.
ABSTRACT
Each year, 1.4 million people in the United States are infected with Salmonella (Beneson et al. [23] Am J Med, 110:60-63, 2001). The most common clinical presentation of Salmonella infection is gastroenteritis which is usually self-limited, lasting between one to four days (Black et al. [24] N Engl J Med, 261:811-816, 1960). Although most infections are mild-to-moderate, serious disease, and death does occur (Voetsch et al. [25] CID, 38:S127-S132, 2004). A rare but increasing number of patients present with Salmonellosis spondylodiscitis resulting from contiguous spread of infection from the adjacent abdominal aorta. Concurrent infection of these structures exacerbates morbidity, necessitating an elevated clinical suspicion in patients with appropriate risk factors, clinical signs and symptoms. Furthermore, an overall mortality rate of 67% makes mycotic abdominal aortic aneurysms highly lethal (Gonda et al. [26] Radiology, 168:343-346, 1988). Thus, early diagnosis is crucial, allowing for prompt antibiotic and surgical management. Laboratory and imaging tests obtained at the initial suspicion for infection of the spine and aorta facilitates diagnosis while minimizing or preventing more serious complications like paresis and aortic rupture. We present a patient with a mycotic abdominal aortic aneurysm infected with Salmonella enteritides that spread to the adjacent lumbar vertebra and left psoas muscle.
