Ivana Galinovic1, Josep Puig, Lars Neeb, Jorge Guibernau, Andre Kemmling, Susanne Siemonsen, Salvador Pedraza, Bastian Cheng, Götz Thomalla, Jens Fiehler, Jochen B Fiebach. 1. From the Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany (I.G., L.N., J.B.F.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (J.P., J.G., S.P.); and Departments of Neurology (A.K., S.S., B.C., G.T.) and Diagnostic and Interventional Neuroradiology (J.F.), University-Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Abstract
BACKGROUND AND PURPOSE: WAKE-UP is a randomized, placebo-controlled MRI-based trial of thrombolysis in wake-up stroke using the mismatch between a lesion's visibility in diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR) sequences as its main imaging inclusion criterion. Visual judgment of lesion conspicuity on FLAIR is however methodically limited by moderate inter-rater agreement. We therefore sought to improve rating homogeneity by incorporating quantitative signal intensity measurements. METHODS:One hundred forty-three data sets of patients with acute ischemic stroke were visually rated by 8 raters with respect to WAKE-UP study inclusion and exclusion criteria, and inter-rater agreement was calculated. A subanalysis was performed on 45 cases to determine a threshold value of relative signal intensity (rSI) between the ischemic lesion and contralateral healthy tissue which best corresponded to a visually established verdict of FLAIR positivity. The usefulness of this threshold in improving inter-rater agreement was evaluated in an additional sample of 50 patients. RESULTS: Inter-rater agreement for inclusion into the WAKE-UP trial was 73% with a free-marginal κ of 0.46. A threshold of rSI which best correlated with the visual rating of lesions as FLAIR positive was 1.20. The addition of rSI measurements to visual evaluation did not change the inter-rater agreement. CONCLUSIONS: Introducing a semiquantitative measure for FLAIR rSI did not improve the agreement between individual raters. However, enhancing visual assessment with rSI measurements can provide reassurance to local investigators in cases of uncertainty.
RCT Entities:
BACKGROUND AND PURPOSE: WAKE-UP is a randomized, placebo-controlled MRI-based trial of thrombolysis in wake-up stroke using the mismatch between a lesion's visibility in diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR) sequences as its main imaging inclusion criterion. Visual judgment of lesion conspicuity on FLAIR is however methodically limited by moderate inter-rater agreement. We therefore sought to improve rating homogeneity by incorporating quantitative signal intensity measurements. METHODS: One hundred forty-three data sets of patients with acute ischemic stroke were visually rated by 8 raters with respect to WAKE-UP study inclusion and exclusion criteria, and inter-rater agreement was calculated. A subanalysis was performed on 45 cases to determine a threshold value of relative signal intensity (rSI) between the ischemic lesion and contralateral healthy tissue which best corresponded to a visually established verdict of FLAIR positivity. The usefulness of this threshold in improving inter-rater agreement was evaluated in an additional sample of 50 patients. RESULTS: Inter-rater agreement for inclusion into the WAKE-UP trial was 73% with a free-marginal κ of 0.46. A threshold of rSI which best correlated with the visual rating of lesions as FLAIR positive was 1.20. The addition of rSI measurements to visual evaluation did not change the inter-rater agreement. CONCLUSIONS: Introducing a semiquantitative measure for FLAIR rSI did not improve the agreement between individual raters. However, enhancing visual assessment with rSI measurements can provide reassurance to local investigators in cases of uncertainty.
Authors: King Chung Ho; William Speier; Haoyue Zhang; Fabien Scalzo; Suzie El-Saden; Corey W Arnold Journal: IEEE Trans Med Imaging Date: 2019-02-25 Impact factor: 10.048
Authors: Götz Thomalla; Florent Boutitie; Henry Ma; Masatoshi Koga; Peter Ringleb; Lee H Schwamm; Ona Wu; Martin Bendszus; Christopher F Bladin; Bruce C V Campbell; Bastian Cheng; Leonid Churilov; Martin Ebinger; Matthias Endres; Jochen B Fiebach; Mayumi Fukuda-Doi; Manabu Inoue; Timothy J Kleinig; Lawrence L Latour; Robin Lemmens; Christopher R Levi; Didier Leys; Kaori Miwa; Carlos A Molina; Keith W Muir; Norbert Nighoghossian; Mark W Parsons; Salvador Pedraza; Peter D Schellinger; Stefan Schwab; Claus Z Simonsen; Shlee S Song; Vincent Thijs; Danilo Toni; Chung Y Hsu; Nils Wahlgren; Haruko Yamamoto; Nawaf Yassi; Sohei Yoshimura; Steven Warach; Werner Hacke; Kazunori Toyoda; Geoffrey A Donnan; Stephen M Davis; Christian Gerloff Journal: Lancet Date: 2020-11-08 Impact factor: 79.321
Authors: Vince I Madai; Ivana Galinovic; Ulrike Grittner; Olivier Zaro-Weber; Alice Schneider; Steve Z Martin; Federico C von Samson-Himmelstjerna; Katharina L Stengl; Matthias A Mutke; Walter Moeller-Hartmann; Martin Ebinger; Jochen B Fiebach; Jan Sobesky Journal: PLoS One Date: 2014-03-21 Impact factor: 3.240