Robert Fahed1, Augustin Lecler2, Candice Sabben2, Naim Khoury2, Célina Ducroux2, Vanessa Chalumeau2, Daniele Botta2, Erwah Kalsoum2, William Boisseau2, Loïc Duron2, Dominique Cabral2, Patricia Koskas2, Azzedine Benaïssa2, Hasmik Koulakian2, Michael Obadia2, Benjamin Maïer2, David Weisenburger-Lile2, Bertrand Lapergue2, Adrien Wang2, Hocine Redjem2, Gabriele Ciccio2, Stanislas Smajda2, Jean-Philippe Desilles2, Mikaël Mazighi2, Malek Ben Maacha2, Inès Akkari2, Kevin Zuber2, Raphaël Blanc2, Jean Raymond2, Michel Piotin2. 1. From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.). robert.fahed@hotmail.fr. 2. From the Interventional Neuroradiology Unit (R.F., C.D., V.C., D.B., W.B., B.M., H.R., G.C., S.S., J.-P.D., M.M., R.B., M.P.), Diagnostic Radiology Unit (A.L., L.D., D.C., P.K.), Neurovascular Unit (C.S., M.O., D.W.-L.), and Research and Biostatistics Unit (M.B.M., I.A., K.Z.), Fondation Rothschild Hospital, Paris, France; HSHS Neuroscience Center, HSHS St. John's Hospital, Springfield, IL (N.K.); Neuroradiology Unit, Henri Mondor Hospital, Creteil, France (E.K., A.B.); Radiology Unit, Cochin Hospital, Paris, France (H.K.); Neurovascular Unit, Foch Hospital, Suresnes, France (B.L., A.W.); and Interventional Neuroradiology Research Laboratory, CHUM Research Center, Notre-Dame Hospital, Montreal, Quebec, Canada (J.R.).
Abstract
BACKGROUND AND PURPOSE: We aimed to study the intrarater and interrater agreement of clinicians attributing DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) mismatch in patients with acute ischemic stroke referred for mechanical thrombectomy. METHODS: Eighteen raters independently scored anonymized magnetic resonance imaging scans of 30 participants from a multicentre thrombectomy trial, in 2 different reading sessions. Agreement was measured using Fleiss κ and Cohen κ statistics. RESULTS: Interrater agreement for DWI-ASPECTS was slight (κ=0.17 [0.14-0.21]). Four raters (22.2%) had a substantial (or higher) intrarater agreement. Dichotomization of the DWI-ASPECTS (0-5 versus 6-10 or 0-6 versus 7-10) increased the interrater agreement to a substantial level (κ=0.62 [0.48-0.75] and 0.68 [0.55-0.79], respectively) and more raters reached a substantial (or higher) intrarater agreement (17/18 raters [94.4%]). Interrater agreement for DWI-FLAIR mismatch was moderate (κ=0.43 [0.33-0.57]); 11 raters (61.1%) reached a substantial (or higher) intrarater agreement. CONCLUSIONS: Agreement between clinicians assessing DWI-ASPECTS and DWI-FLAIR mismatch may not be sufficient to make repeatable clinical decisions in mechanical thrombectomy. The dichotomization of the DWI-ASPECTS (0-5 versus 0-6 or 0-6 versus 7-10) improved interrater and intrarater agreement, however, its relevance for patients selection for mechanical thrombectomy needs to be validated in a randomized trial.
BACKGROUND AND PURPOSE: We aimed to study the intrarater and interrater agreement of clinicians attributing DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) mismatch in patients with acute ischemic stroke referred for mechanical thrombectomy. METHODS: Eighteen raters independently scored anonymized magnetic resonance imaging scans of 30 participants from a multicentre thrombectomy trial, in 2 different reading sessions. Agreement was measured using Fleiss κ and Cohen κ statistics. RESULTS: Interrater agreement for DWI-ASPECTS was slight (κ=0.17 [0.14-0.21]). Four raters (22.2%) had a substantial (or higher) intrarater agreement. Dichotomization of the DWI-ASPECTS (0-5 versus 6-10 or 0-6 versus 7-10) increased the interrater agreement to a substantial level (κ=0.62 [0.48-0.75] and 0.68 [0.55-0.79], respectively) and more raters reached a substantial (or higher) intrarater agreement (17/18 raters [94.4%]). Interrater agreement for DWI-FLAIR mismatch was moderate (κ=0.43 [0.33-0.57]); 11 raters (61.1%) reached a substantial (or higher) intrarater agreement. CONCLUSIONS: Agreement between clinicians assessing DWI-ASPECTS and DWI-FLAIR mismatch may not be sufficient to make repeatable clinical decisions in mechanical thrombectomy. The dichotomization of the DWI-ASPECTS (0-5 versus 0-6 or 0-6 versus 7-10) improved interrater and intrarater agreement, however, its relevance for patients selection for mechanical thrombectomy needs to be validated in a randomized trial.
Authors: M T Berndt; D Pürner; C Maegerlein; S Wunderlich; B Friedrich; C Zimmer; D Sepp; J Kaesmacher; T Boeckh-Behrens Journal: AJNR Am J Neuroradiol Date: 2020-12-10 Impact factor: 3.825
Authors: Julian Schröder; Bastian Cheng; Caroline Malherbe; Martin Ebinger; Martin Köhrmann; Ona Wu; Dong-Wha Kang; David S Liebeskind; Thomas Tourdias; Oliver C Singer; Bruce Campbell; Marie Luby; Steven Warach; Jens Fiehler; André Kemmling; Jochen B Fiebach; Christian Gerloff; Götz Thomalla Journal: Front Neurol Date: 2018-04-23 Impact factor: 4.003