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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">K. Nael</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">May 2020,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E29; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6504 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-75152--69215781" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">K. Nael </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of Radiological SciencesDavid Geffen School of Medicine at UCLALos Angeles, California</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=K.%2BNael%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Nael%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AK.%2BNael%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-4194-9488" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. Nael</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p id="p-1">We thank Drs Suss and Pinho for their interest in reading our article and sharing their opinion on the use of ASPECTS in patients with acute ischemic stroke. Several valid points have been raised about the limitations of ASPECTS, with which we agree.</p><p id="p-2">Regardless of its limitations, ASPECTS is currently being used for treatment decision-making in patients with acute stroke who present  &lt;6 hours from symptom onset. This use is supported by a strong level of evidence that has emerged from randomized clinical trials and is included in the latest American Heart Association guidelines.<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup></p><p id="p-3">Volume (of ischemic core) measurements if accurate and reliable can improve the screening process of patients with acute ischemic stroke and avoid several shortcomings of ASPECTS, including variability and ambiguity associated with the binary nature of ASPECTS.</p><p id="p-4">While we have seen the successful use of ischemic core volume estimation obtained from CT perfusion or MR imaging to treat patients with stroke presenting beyond 6 hours from onset,<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup> current data on volumetric estimates of ischemic core via NCCT alone are limited. It is plausible that with a future successful large, prospective study, volumetric assessment of ischemic core on NCCT could potentially replace ASPECTS. This scenario may be not too far ahead, in particular considering the emergence of deep learning techniques with the potential for making this process even more reliable and effortless.<sup><a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a></sup></p><div class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-41.5.E29.1" data-doi="10.1161/STR.0000000000000158"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Powers</span>  <span class="cit-name-given-names">WJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Rabinstein</span>  <span class="cit-name-given-names">AA</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ackerson</span>  <span class="cit-name-given-names">T</span></span>, <span class="cit-etal">et al</span></li></ol><cite>; <span class="cit-auth cit-collab">American Heart Association Stroke Council</span>. <span class="cit-article-title">2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association</span>. <abbr class="cit-jnl-abbrev">Stroke</abbr> <span class="cit-pub-date">2018</span>;<span class="cit-vol">49</span>:<span class="cit-fpage">e46</span>–<span class="cit-lpage">110</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1161/STR.0000000000000158</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>29367334</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToic3Ryb2tlYWhhIjtzOjU6InJlc2lkIjtzOjg6IjQ5LzMvZTQ2IjtzOjQ6ImF0b20iO3M6MTk6Ii9ham5yLzQxLzUvRTI5LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-41.5.E29.2" data-doi="10.1056/NEJMoa1713973"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Albers</span>  <span class="cit-name-given-names">GW</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Marks</span>  <span class="cit-name-given-names">MP</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kemp</span>  <span class="cit-name-given-names">S</span></span>, <span class="cit-etal">et al</span></li></ol><cite>; <span class="cit-auth cit-collab">DEFUSE 3 Investigators</span>. <span class="cit-article-title">Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging</span>. <abbr class="cit-jnl-abbrev">N Engl J Med</abbr> <span class="cit-pub-date">2018</span>;<span class="cit-vol">378</span>:<span class="cit-fpage">708</span>–<span class="cit-lpage">18</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1056/NEJMoa1713973</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>29364767</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1056/NEJMoa1713973&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=29364767&amp;link_type=MED&amp;atom=%2Fajnr%2F41%2F5%2FE29.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a><div class="cit ref-cit ref-journal" id="cit-41.5.E29.3" data-doi="10.1148/radiol.2020192703"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Nael</span>  <span class="cit-name-given-names">K</span></span></li></ol><cite>. <span class="cit-article-title">Detection of acute infarction on non-contrast-enhanced CT: closing the gap with MRI via machine learning</span>. <abbr class="cit-jnl-abbrev">Radiology</abbr> <span class="cit-pub-date">2020</span>;<span class="cit-vol">294</span>:<span class="cit-fpage">645</span>–<span class="cit-lpage">46</span><span class="cit-pub-id-sep cit-pub-id-doi-sep"> </span><span class="cit-pub-id cit-pub-id-doi"><span class="cit-pub-id-scheme-doi">doi:</span>10.1148/radiol.2020192703</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>31990628</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1148/radiol.2020192703&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=31990628&amp;link_type=MED&amp;atom=%2Fajnr%2F41%2F5%2FE29.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2020 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 41</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 5 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 May 2020 </div></div>
      
      
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