Publication details

Interrater Agreement and Detection Accuracy for Medium-Vessel Occlusions Using Single-Phase and Multiphase CT Angiography

Authors

OSPEL J. M. BALA F. MCDONOUGH R. V. VOLNÝ Ondřej KASHANI N. QIU W.. MENON B. K. GOYAL M.

Year of publication 2022
Type Article in Periodical
Magazine / Source American Journal of Neuroradiology
MU Faculty or unit

Faculty of Medicine

Citation
web http://www.ajnr.org/content/early/2021/11/25/ajnr.A7361
Doi http://dx.doi.org/10.3174/ajnr.A7361
Keywords Medium-Vessel Occlusions; Single-Phase and Multiphase CT Angiography
Description 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 ? 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 (? ?=?0.58; 95% CI, 0.56?0.62) and almost perfect for multiphase CTA (? = 0.81; 95% CI, 0.78?0.83). Interrater agreement for detailed occlusion sites was moderate for single-phase CTA (? = 0.55; 95% CI, 0.53?0.56) and substantial for multiphase CTA (? = 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.

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