Ronda Lun1, Gregory B Walker1,2, Adrien Guenego3, Mohammed Kassab4,5, Eduardo Portela5, Vignan Yogendrakumar1, George Medvedev2, Ken Wong6, Michel Shamy1,7, Dar Dowlatshahi1,7, Robert Fahed1,5,7. 1. Ottawa Stroke Program, Department of Medicine (Neurology), University of Ottawa, Ottawa, ON, Canada. 2. Division of Neurology, Fraser Health Authority, Royal Columbian Hospital, New Westminster, BC, Canada. 3. Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium. 4. Division of Neurosurgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada. 5. Interventional Neuroradiology, Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada. 6. Division of Medical Imaging, Fraser Health Authority, Royal Columbian Hospital, New Westminster, BC, Canada. 7. Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Abstract
Background: Hemorrhagic transformation after acute ischemic stroke is a dreaded and severe complication of thrombolysis and thrombectomy. However, its detection on post-thrombectomy conventional non-contrast computed tomography (CT) scan can be complicated by the frequent (and sometimes concomitant) presence of contrast, resulting in changes in management. Aims: Our objective was to assess the inter- and intra-rater reliability for the detection of blood and/or contrast on day-1 post-thrombectomy CT scans. Methods: A total of 18 raters across 3 different specialties independently examined 30 post-thrombectomy CT scans selected from the Aspiration vs. STEnt-Retriever (ASTER) trial. They were asked to judge the presence of blood and contrast. Thirty days later, the same 18 raters again independently judged the 30 scans, in randomized order. Agreement was measured with Fleiss' and Cohen's K statistics. Results: Overall agreement on blood and/ or contrast presence was only fair, k = 0.291 (95% CI = 0.273-0.309). There were 0 scans with consensus among the 18 readers on the presence of blood and/or contrast. However, intra-rater global agreement across all 18 physicians was relatively high, with a median kappa value of 0.675. This intra-rater consistency was seen across all specialties, regardless of level of training. Conclusion: Physician judgment for the presence of blood and/or contrast on day-1 post-thrombectomy non-contrast CT scan shows limited inter-observer reliability. Advanced imaging modalities may then be warranted for challenging clinical cases.
Background: Hemorrhagic transformation after acute ischemic stroke is a dreaded and severe complication of thrombolysis and thrombectomy. However, its detection on post-thrombectomy conventional non-contrast computed tomography (CT) scan can be complicated by the frequent (and sometimes concomitant) presence of contrast, resulting in changes in management. Aims: Our objective was to assess the inter- and intra-rater reliability for the detection of blood and/or contrast on day-1 post-thrombectomy CT scans. Methods: A total of 18 raters across 3 different specialties independently examined 30 post-thrombectomy CT scans selected from the Aspiration vs. STEnt-Retriever (ASTER) trial. They were asked to judge the presence of blood and contrast. Thirty days later, the same 18 raters again independently judged the 30 scans, in randomized order. Agreement was measured with Fleiss' and Cohen's K statistics. Results: Overall agreement on blood and/ or contrast presence was only fair, k = 0.291 (95% CI = 0.273-0.309). There were 0 scans with consensus among the 18 readers on the presence of blood and/or contrast. However, intra-rater global agreement across all 18 physicians was relatively high, with a median kappa value of 0.675. This intra-rater consistency was seen across all specialties, regardless of level of training. Conclusion: Physician judgment for the presence of blood and/or contrast on day-1 post-thrombectomy non-contrast CT scan shows limited inter-observer reliability. Advanced imaging modalities may then be warranted for challenging clinical cases.
Authors: G Parrilla; B García-Villalba; M Espinosa de Rueda; J Zamarro; E Carrión; F Hernández-Fernández; J Martín; R Hernández-Clares; A Morales; A Moreno Journal: AJNR Am J Neuroradiol Date: 2012-04-26 Impact factor: 3.825
Authors: A Guenego; A Lecler; J Raymond; C Sabben; N Khoury; K Premat; D Botta; W Boisseau; B Maïer; G Ciccio; H Redjem; S Smajda; C Ducroux; L Di Meglio; V Davy; J M Olivot; A Wang; J Duplantier; M Roques; S Krystal; P Koskas; A Collin; M Ben Maacha; M Hamdani; K Zuber; R Blanc; M Piotin; R Fahed Journal: Eur J Neurol Date: 2018-12-07 Impact factor: 6.089
Authors: Rüdiger von Kummer; Joseph P Broderick; Bruce C V Campbell; Andrew Demchuk; Mayank Goyal; Michael D Hill; Kilian M Treurniet; Charles B L M Majoie; Henk A Marquering; Michael V Mazya; Luis San Román; Jeffrey L Saver; Daniel Strbian; William Whiteley; Werner Hacke Journal: Stroke Date: 2015-09-01 Impact factor: 7.914