J M Ospel1,2, F Bala1, R V McDonough1, O Volny3,4, N Kashani1,5, W Qiu1, B K Menon1,5, M Goyal6,5. 1. From the Department of Diagnostic Imaging (J.M.O., F.B., R.V.M., N.K., W.Q., B.K.M., M.G.). 2. Department of Radiology (J.M.O.), University Hospital of Basel, Basel, Switzerland. 3. Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (O.V.), Masaryk University, Brno, Czech. 4. Department of Neurology (O.V.), University Hospital Ostrava, Ostrava, Czech. 5. Department of Clinical Neurosciences (N.K., B.K.M., M.G.), University of Calgary, Calgary, Alberta, Canada. 6. From the Department of Diagnostic Imaging (J.M.O., F.B., R.V.M., N.K., W.Q., B.K.M., M.G.) mgoyal@ucalgary.ca.
Abstract
BACKGROUND AND PURPOSE: Accurate and reliable detection of medium-vessel occlusions is important to establish the diagnosis of acute ischemic stroke and initiate appropriate treatment with intravenous thrombolysis or endovascular thrombectomy. However, medium-vessel occlusions are often challenging to detect, especially for unexperienced readers. We aimed to evaluate the accuracy and interrater agreement of the detection of medium-vessel occlusions using single-phase and multiphase CTA. MATERIALS AND METHODS: Single-phase and multiphase CTA of 120 patients with acute ischemic stroke (20 with no occlusion, 44 with large-vessel occlusion, and 56 with medium-vessel occlusion in the anterior and posterior circulation) were assessed by 3 readers with varying levels of experience (session 1: single-phase CTA; session 2: multiphase CTA). Interrater agreement for occlusion type (large-vessel occlusion versus medium-vessel occlusion versus no occlusion) and for detailed occlusion sites was calculated using the Fleiss κ with 95% confidence intervals. Accuracy for the detection of medium-vessel occlusions was calculated for each reader using classification tables. RESULTS: Interrater agreement for occlusion type was moderate for single-phase CTA (κ = 0.58; 95% CI, 0.56-0.62) and almost perfect for multiphase CTA (κ = 0.81; 95% CI, 0.78-0.83). Interrater agreement for detailed occlusion sites was moderate for single-phase CTA (κ = 0.55; 95% CI, 0.53-0.56) and substantial for multiphase CTA (κ = 0.71; 95% CI, 0.67-0.74). On single-phase CTA, readers 1, 2, and 3 classified 33/56 (59%), 34/56 (61%), and 32/56 (57%) correctly as medium-vessel occlusions. On multiphase CTA, 48/56 (86%), 50/56 (89%), and 50/56 (89%) medium-vessel occlusions were classified correctly. CONCLUSIONS: Interrater agreement for medium-vessel occlusions is moderate when using single-phase CTA and almost perfect with multiphase CTA. Detection accuracy is substantially higher with multiphase CTA compared with single-phase CTA, suggesting that multiphase CTA might be a valuable tool for assessment of medium-vessel occlusion stroke.
BACKGROUND AND PURPOSE: Accurate and reliable detection of medium-vessel occlusions is important to establish the diagnosis of acute ischemic stroke and initiate appropriate treatment with intravenous thrombolysis or endovascular thrombectomy. However, medium-vessel occlusions are often challenging to detect, especially for unexperienced readers. We aimed to evaluate the accuracy and interrater agreement of the detection of medium-vessel occlusions using single-phase and multiphase CTA. MATERIALS AND METHODS: Single-phase and multiphase CTA of 120 patients with acute ischemic stroke (20 with no occlusion, 44 with large-vessel occlusion, and 56 with medium-vessel occlusion in the anterior and posterior circulation) were assessed by 3 readers with varying levels of experience (session 1: single-phase CTA; session 2: multiphase CTA). Interrater agreement for occlusion type (large-vessel occlusion versus medium-vessel occlusion versus no occlusion) and for detailed occlusion sites was calculated using the Fleiss κ with 95% confidence intervals. Accuracy for the detection of medium-vessel occlusions was calculated for each reader using classification tables. RESULTS: Interrater agreement for occlusion type was moderate for single-phase CTA (κ = 0.58; 95% CI, 0.56-0.62) and almost perfect for multiphase CTA (κ = 0.81; 95% CI, 0.78-0.83). Interrater agreement for detailed occlusion sites was moderate for single-phase CTA (κ = 0.55; 95% CI, 0.53-0.56) and substantial for multiphase CTA (κ = 0.71; 95% CI, 0.67-0.74). On single-phase CTA, readers 1, 2, and 3 classified 33/56 (59%), 34/56 (61%), and 32/56 (57%) correctly as medium-vessel occlusions. On multiphase CTA, 48/56 (86%), 50/56 (89%), and 50/56 (89%) medium-vessel occlusions were classified correctly. CONCLUSIONS: Interrater agreement for medium-vessel occlusions is moderate when using single-phase CTA and almost perfect with multiphase CTA. Detection accuracy is substantially higher with multiphase CTA compared with single-phase CTA, suggesting that multiphase CTA might be a valuable tool for assessment of medium-vessel occlusion stroke.
Authors: Bijoy K Menon; Christopher D d'Esterre; Emmad M Qazi; Mohammed Almekhlafi; Leszek Hahn; Andrew M Demchuk; Mayank Goyal Journal: Radiology Date: 2015-01-29 Impact factor: 11.105
Authors: Bijoy K Menon; Michael D Hill; Antoni Davalos; Yvo B W E M Roos; Bruce C V Campbell; Diederik W J Dippel; Francis Guillemin; Jeffrey L Saver; Aad van der Lugt; Andrew M Demchuk; Keith Muir; Scott Brown; Tudor Jovin; Peter Mitchell; Phil White; Serge Bracard; Mayank Goyal Journal: J Neurointerv Surg Date: 2019-04-11 Impact factor: 5.836
Authors: Johanna M Ospel; Bijoy K Menon; Andrew M Demchuk; Mohammed A Almekhlafi; Nima Kashani; Arnuv Mayank; Enrico Fainardi; Marta Rubiera; Alexander Khaw; Jai J Shankar; Dar Dowlatshahi; Josep Puig; Sung-Il Sohn; Seong H Ahn; Alexandre Poppe; Ana Calleja; Michael D Hill; Mayank Goyal Journal: Stroke Date: 2020-10-19 Impact factor: 7.914
Authors: Petra Cimflova; Manon Kappelhof; Nishita Singh; Nima Kashani; Johanna Maria Ospel; Rosalie McDonough; Andrew M Demchuk; Bijoy K Menon; Nobuyuki Sakai; Michael Chen; Jens Fiehler; Mayank Goyal Journal: J Neurointerv Surg Date: 2021-05-04 Impact factor: 5.836