Aim: This study aimed to compare the agreement between total Alberta Stroke Program Early CT Score (ASPECTS) and region-based scores from two automated ASPECTS software packages and an expert consensus (EC) reading with the final ASPECTS in patients who had prompt reperfusion from endovascular thrombectomy (EVT).

Methods: ASPECTS were retrospectively and blindly assessed by two software packages and EC on baseline non-contrast-enhanced CT (NCCT) images. Patients had multimodal CT imaging demonstrating acute anterior circulation ischemic stroke with large vessel occlusion. Final ASPECTS from follow-up scans in patients with EVT and complete reperfusion within 100 minutes were compared to total and region-based scores.

Results: 52 patients met the criteria. Moderate agreement was observed between both software packages and EC for total ASPECTS, with no significant performance difference. However, the software packages showed different regional contributions. Package A was more sensitive in cortical areas but less specific, while EC and Package B were more sensitive for deep structures but less specific.

Conclusion: No clinically significant difference was found for total ASPECT score between human and automated packages, though there were differences in regional scoring characteristics.