Albers GW, Wald MJ, Mlynash M, et al. - Among patients with large hemispheric infarcts, the authors compared the Alberta Stroke Program Early CT Score (ASPECTS), calculated using a machine learning-based automatic software tool, RAPID ASPECTS, as well as the median score from 4 experienced readers, with the diffusion-weighted imaging (DWI) ASPECTS obtained following the baseline CT. CT and MRI scans from the GAMES-RP study, which recruited patients with large hemispheric infarctions (82–300 mL) documented on DWI-MRI, were evaluated by blinded experienced readers to determine both CT and DWI ASPECTS. Data reported that the median CT ASPECTS for the clinicians was 5 (interquartile range, 4–7), for RAPID ASPECTS 3 (interquartile range, 1–6), and for DWI ASPECTS 3 (2–4). It was noted that median error for RAPID ASPECTS was 1 (interquartile range, −1 to 3) compared with 3 (interquartile range, 1–4) for clinicians (P<0.001). The automated score had a higher level of agreement with the DWI ASPECTS median for both the full scale and when dichotomized at < 6 vs 6 or more (difference in intraclass correlation coefficient). In identifying early evidence of brain ischemia as documented by DWI, RAPID ASPECTS was more accurate than experienced clinicians.