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  • CT
  • MCA or ICA occlusion


CINA-ASPECTS is a computer-aided diagnosis software device used to assist clinicians, including stroke physicians and radiologists, in the assessment and characterization of brain tissue abnormalities using CT image data. Is indicated for evaluation of patients presenting for diagnostic imaging workup with known MCA or ICA occlusion, for evaluation of extent of disease and provides information that may be useful in the characterization of early ischemic (acute) brain tissue injury during image interpretation.1


Images shown for illustrative purposes only.


CINA (for ICH) uses deep learning to identify suspected intracranial hemorrhage (ICH) and prioritizes those cases in the worklist, reducing turnaround time for head trauma and stroke patients.1,2,3


CINA (for ICH) performed well, with an accuracy of 95.6%, sensitivity of 91.4%, and specificity of 97.5%. ICH was further stratified into the following subtypes:


intraparenchymal, intraventricular, epidural/ subdural, and subarachnoid with true positive rates of 92.9, 100, 94.3, and 89.9%, respectively.3



CINA (for LVO) performed well in the LVO cohort, with an accuracy of 98.1%, sensitivity of 98.1%, and specificity of 98.2%.3


The algorithm also showed robust performance in detecting LVO location in a smaller subset of cases with an accuracy of 97.0%, sensitivity of 94.3%, and specificity of 97.4%.3

Clinical Workflow

Aspects workflow
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    Non-enhanced (non-contract) head CT images

    Matrix size ≥256 x 256 (rectangular matrix accepted)

    Axial acquisition only

    Slice thickness ≤ 2.5 mm with no gap between successive slices

    Head First-Supine (HFS) or Feet First-Supine (FFS) patient position

    Radiation dose parameters: 100 kVp to 160 kVp, recommended: 120 to 140 kVp,

    Reconstruction diameter above 170 mm,

    Soft tissue reconstruction kernel.

    Reconstruction diameter above 170 mm

    Soft tissue reconstruction kernel.

    Series are processed by running the CINA-ASPECTS Image Processing Application on non-contrast head CT images (NCCT) and provides:  

    Two illustrative ASPECTS slices with the six cortical regions (M1-M6), and the four basal ganglia regions (caudate, lentiform, insula, and internal capsule).  

    • A summary table with the information below:
      • The automatically generated ASPECT score displayed in:
        • Red if it is less or equal to 5,
        • Orange if it is equal to 6 or 7,
        • White if its value is between 8 and 10,
    • The list of ASPECTS regions, identified as infarct, in which early ischemic change (low attenuation and/or sulcal effacement) has been identified,
    • The mean Hounsfield value within each ASPECTS region.


    CINA (for LVO)

    LVO workflow

    For CalanticTM software version 1.0.0, no prior study will be examined.

    *ICH refers to intracranial haemorrhage; SAH to subarachnoid haemorrhage; SDH to subdural haemorrhage; IPH to intraparenchymal haemorrhage; IVH to intraventricular haemorrhage; and EDH to epidural haemorrhage.

      EU risk class and CE marking       
      CINA-ASPECTS has CE marking and risk class I.

      Reimbursement status       
      Not reimbursed.


      • CINA-ASPECTS is not intended for use with head CT scans acquired in the presence of contrast media.
      • CINA-ASPECTS is not intended for use on head CT scans containing evidence of hemorrhage (intracranial, subarachnoid, microbleeds, etc.).
      • CINA-ASPECTS is not intended for use on head CT scans displaying neurological pathologies other than acute ischemic stroke, such as tumors or abscesses, or post-surgical conditions, such as craniectomy.

      Target population

      • CINA (for ICH): Patients with suspected ICH.
      • CINA (for LVO): Patients with suspected LVO.


      • Despite the data quality check performed by CINA-ASPECTS on DICOM data (please refer to section: Acquisition protocol requirements for an optimal use), the limitations below refer to situations in which the device ASPECTS may provide incorrect scoring:
        • Inadequate field of view,
        • Notable image noise,
        • Significant motion artifacts,
        • Severe streak artifacts,
      • Presence of chronic (old) infarcts. CINA-ASPECTS is not intended to detect chronic (old) infarcts and may incorrectly classify them as early ischemic changes.
      • The automatically generated ASPECT score is provided for informational purposes; the definite ASPECT being established by clinicians which are ultimately responsible for reviewing full images per the ASPECTS standard of care radiologist assessment.
        Instructions for Use CINA-ASPECTS, software version 1.4
        Shibata, S., Sakurai, K., Tachikawa, K., Ko, R., Hino, S., Fukano, T., Isahaya, K., Haraguchi, T., Yamauchi, J., Tanabe, K., Nagasaka, M., Hagiwara, Y., Shimizu, T., Akiyama, H., Kobayashi, Y., Hasegawa, Y., & Yamano, Y. (2022). The Utility of Automated ASPECTS in Acute Ischemic Stroke for Intravenous Recombinant Tissue Plasminogen Activator (IV-rtPA) Therapy. Neurology international, 14(4), 981–990. https://doi.org/10.3390/neurolint14040077
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