Although techniques have been described that increase visibility of EICs on NCCT scan,9,39–41 comparative data are limited since most methods are based on MR imaging, accuracy is not always reported and none have been correlated to clinical outcome. Although diffusion-weighted MRI is considered the gold standard for assessing EICs, MRI is rarely available in the emergency setting of patients with acute stroke and consequently it is not the standard care.42 Our method was, therefore, developed for NCCT, which is the standard initial imaging examination for acute stroke, since it is fast, inexpensive, widely and easily available, and provides whole brain coverage.43 A limitation of this study is, therefore, that no gold-standard (MRI) of the EICs was available. We could only compare the automated scoring with manual scoring, which had considerable observer variability. The variation of the manual ASPECTS limits the value of the reference measurement, however, accurately it resembles the expected variation in clinical practice. The variation in manual ASPECTS was a main motivation to initiate this study on an objective automated approach knowing that a direct comparison with observers cannot prove any improvements.