Performance of an artificial intelligence tool for multi-step acute stroke imaging: A multicenter diagnostic study.

Objective: Several artificial intelligence (AI) tools have been developed to assist in the stroke imaging workflow, which remains a major disease of the 21st century. This study evaluated the combined performance of an FDA-cleared and CE-marked AI-based device with three modules designed to detect intracerebral hemorrhage (ICH), identify large vessel occlusion (LVO), and calculate Alberta Stroke Program Early CT Scores (ASPECTS). Materials & methods: Non-contrast CT (NCCT) and/or computed tomography angiography (CTA) for suspicion of stroke acquired at La Timone and Nord University hospitals (Marseille, France) between March 2019 and March 2020 were retrospectively collected. The AI tool, CINA-HEAD (Avicenna.AI), processed the data to flag ICH, LVO, and calculate ASPECTS. The results were compared to ground truth evaluations by four expert neuroradiologists to compute diagnostic performances. Results: A total of 373 NCCT and 331 CTA from 405 patients (mean age 64.9 ± 18.9 SD, 52.6 % female) were included. The AI tool achieved an accuracy of 94.6 % [95 % CI: 91.8 %-96.7 %] for ICH detection on NCCT and of 86.4 % [95 % CI: 82.2 %-89.9 %] for LVO identification on CTA. The region-based ASPECTS analysis yielded an accuracy of 88.6 % [95 % CI: 87.8 %-89.3 %] and the dichotomized ASPECTS classification (ASPECTS ≥ 6) achieved 80.4 % accuracy. Conclusion: This study demonstrates the reliable, stepwise performance of an AI-based stroke imaging tool across the diagnostic cascade of ICH and LVO detection and ASPECTS scoring. Such robust multi-stage evaluation supports its potential for streamlining acute stroke triage and decision-making.