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BACKGROUND AND PURPOSE: ASPECTS quantifies early ischemic changes in anterior circulation stroke on NCCT but has interrater variability. We examined the agreement of conventional and automated ASPECTS and studied the value of computer-aided detection. MATERIALS AND METHODS: We retrospectively collected imaging data from consecutive patients with acute ischemic stroke with large-vessel occlusion undergoing thrombectomy. Five raters scored conventional ASPECTS on baseline NCCTs, which were also processed by RAPID software. Conventional and automated ASPECTS were compared with a consensus criterion standard. We determined the agreement over the full ASPECTS range as well as dichotomized, reflecting thrombectomy eligibility according to the guidelines (ASPECTS 0–5 versus 6–10). Raters subsequently scored ASPECTS on the same NCCTs with assistance of the automated ASPECTS outputs, and agreement was obtained. RESULTS: For the total of 175 cases, agreement among raters individually and the criterion standard varied from fair to good (weighted κ = between 0.38 and 0.76) and was moderate (weighted κ = 0.59) for the automated ASPECTS. The agreement of all raters individually versus the criterion standard improved with software assistance, as did the interrater agreement (overall Fleiss κ = 0.15–0.23; P < .001 and .39 to .55; P = .01 for the dichotomized ASPECTS). CONCLUSIONS: Automated ASPECTS had agreement with the criterion standard similar to that of conventional ASPECTS. However, including automated ASPECTS during the evaluation of NCCT in acute stroke improved the agreement with the criterion standard and improved interrater agreement, which could, therefore, result in more uniform scoring in clinical practice. CAD : computer-aided detection and diagnosis

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Abstract Extracorporeal membrane oxygenation (ECMO) is a vital life support technique employed in patients experiencing pulmonary or cardiopulmonary failure. This procedure entails the use of a pump to replace heart function and an oxygenator to ensure adequate blood oxygenation. ECMO systems are categorized into two main configurations: veno-venous (VV) and veno-arterial (VA) circuits. VV-ECMO is employed for isolated respiratory failure, while VA-ECMO provides temporary mechanical circulatory support for patients with cardiogenic shock or cardiac arrest. A less common alternative, veno-arterial-venous (VAV) ECMO, may be used in complex cases, reducing left ventricular afterload, leading to an improvement of pulmonary edema. Imaging plays a pivotal role in ECMO management, particularly in confirming proper cannula placement, detecting malposition or migration, and identifying complications such as hemorrhage, thrombosis, vascular injury, or infections. Chest X-ray serves as the first-line imaging modality, while computed tomography (CT) is essential for a more detailed evaluation in cases of suspected complications. Tailored CT protocols, adapted to specific ECMO configurations, contrast injection site, cardiac output, and ECMO flow rate, are essential to account for possible ECMO-induced hemodynamic changes and ensure accurate diagnosis. This review provides a comprehensive guide for radiologists, offering detailed descriptions of ECMO system configurations, cannula positioning, and imaging techniques. It highlights the importance of understanding ECMO-specific challenges and outlines strategies to optimize imaging protocols, including modifications in contrast administration and flow-rate adjustments, ultimately improving diagnostic accuracy and patient outcomes. Critical relevance statement Radiologists must be familiar with VV- and VA-ECMO systems, utilize tailored CT protocols, and apply non-invasive imaging modalities to assess cannula positioning and complic