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Peer-reviewedCC BY 4.0Frontiers in Neurology

The reliability conundrum of DWI-ASPECTS in stroke assessment: a systematic review of agreement on DWI-ASPECTS in anterior circulation stroke

  • Mobin Jamal1
  • Vincent Brissette1
  • Gabriele Zitikyte1
  • Michel Shamy1,2
  • Robert Fahed1,2
  1. 1Department of Medicine (Neurology), The Ottawa Hospital
  2. 2Ottawa Hospital Research Institute, University of Ottawa
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Abstract

Background: The DWI-ASPECT score (DWI-ASPECTS) can aid patients’ selection for thrombectomy. This systematic review aimed to evaluate clinicians’ interrater and intrarater agreement on DWI-ASPECTS for anterior circulation stroke patients.

Methods: We conducted a broad search of electronic databases (CINAHL, EBM Reviews, MEDLINE, EMBASE & EMBASE Classic) between January 1st, 2000, and September 9 th , 2026. Our primary outcome was to collect data on any available measures of agreement for DWI-ASPECTS. Measures of agreement collected included ICC (intraclass correlation coefficient), weighted or unweighted kappa.

Results: Out of 3,658 articles screened, nineteen studies reporting 37 measures of agreement were included in the review. Populations, methods, analyses, and results were heterogeneous (poor to excellent agreement), precluding a meta-analysis. For interrater agreement, measures of agreement using full scale ICC ranged from strong to excellent, ranged from poor to strong using unweighted kappa, and ranged from moderate to excellent using weighted kappa. Only four studies offered interrater agreement values on DWI-ASPECTS<6. Only two studies offered information on intrarater agreement values.

Conclusion: Data on the reliability of DWI-ASPECTS in acute ischemic stroke is scant, while the methodologies and results in the studies assessed are heterogeneous. More robust studies are required, particularly for strokes with DWI-ASPECTS <6.

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Cite

BibTeXRIS
BibTeX
@article{jamal2026reliability,
  title = {{The reliability conundrum of DWI-ASPECTS in stroke assessment: a systematic review of agreement on DWI-ASPECTS in anterior circulation stroke}},
  author = {Mobin Jamal and Vincent Brissette and Gabriele Zitikyte and Michel Shamy and Robert Fahed},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1900599},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1900599/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - The reliability conundrum of DWI-ASPECTS in stroke assessment: a systematic review of agreement on DWI-ASPECTS in anterior circulation stroke
AU  - Mobin Jamal
AU  - Vincent Brissette
AU  - Gabriele Zitikyte
AU  - Michel Shamy
AU  - Robert Fahed
PY  - 2026
DA  - 2026/10/23
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1900599
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1900599/full
AB  - Background: The DWI-ASPECT score (DWI-ASPECTS) can aid patients’ selection for thrombectomy. This systematic review aimed to evaluate clinicians’ interrater and intrarater agreement on DWI-ASPECTS for anterior circulation stroke patients.  Methods: We conducted a broad search of electronic databases (CINAHL, EBM Reviews, MEDLINE, EMBASE & EMBASE Classic) between January 1st, 2000, and September 9 th , 2026. Our primary outcome was to collect data on any available measures of agreement for DWI-ASPECTS. Measures of agreement collected included ICC (intraclass correlation coefficient), weighted or unweighted kappa.  Results: Out of 3,658 articles screened, nineteen studies reporting 37 measures of agreement were included in the review. Populations, methods, analyses, and results were heterogeneous (poor to excellent agreement), precluding a meta-analysis. For interrater agreement, measures of agreement using full scale ICC ranged from strong to excellent, ranged from poor to strong using unweighted kappa, and ranged from moderate to excellent using weighted kappa. Only four studies offered interrater agreement values on DWI-ASPECTS<6. Only two studies offered information on intrarater agreement values.  Conclusion: Data on the reliability of DWI-ASPECTS in acute ischemic stroke is scant, while the methodologies and results in the studies assessed are heterogeneous. More robust studies are required, particularly for strokes with DWI-ASPECTS <6.
SN  - 1664-2295
ER  -