Kalafut M A, Schriger D L, Saver J L, Starkman S
Scripps Clinic, Division of Neurology, La Jolla, CA, USA.
Stroke. 2000 Jul;31(7):1667-71. doi: 10.1161/01.str.31.7.1667.
This study had 2 goals: (1) to assess interrater reliability of academic neuroradiologists when classifying acute infarction by CT scan as >1/3 middle cerebral artery (MCA) involvement, <1/3 MCA involvement, or no infarction and (2) to determine the sensitivity of physicians potentially involved in acute stroke treatment in detecting >1/3 MCA acute infarctions. Studies of tissue plasminogen activator show an association between early signs of major infarction and poor outcome. The American Academy of Neurology and the American Heart Association recommend avoiding thrombolysis if early signs of major infarction are present.
We presented 25 scans (normals, acute infarctions, and old infarctions) to 3 academic neuroradiologists. A scoring sheet based on Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS)/CT Summit criteria was used to determine >1/3 MCA territory involvement. Nine of the 25 scans were presented again to assess intrarater reliability. We recalculated results of our previous study in which physicians interpreted infarction scans, now designating the scans as >1/3 MCA, <1/3 MCA, or normal, as determined by the neuroradiologists.
All 3 neuroradiologists agreed on no infarction, <1/3 MCA, and >1/3 MCA on 64% of the scans. Neuroradiologist test-retest agreement was 96% for >1/3 MCA territory. Overall sensitivity for emergency physicians, neurologists, and general radiologists for detecting the presence of infarction in scans rated as >1/3 MCA was 78%.
Neuroradiologists can achieve moderate agreement in detecting >1/3 MCA infarction. The emergency physicians, neurologists, and general radiologists tested were reasonably skilled at detecting >1/3 MCA acute infarction. However, their performance did not reliably identify all patients who have early CT infarct signs that place them at increased risk for cerebral hemorrhage after thrombolytic therapy.
本研究有两个目标：（1）评估学术神经放射科医生在通过CT扫描将急性梗死分类为大脑中动脉（MCA）累及超过1/3、累及不到1/3或无梗死时的评分者间可靠性；（2）确定可能参与急性卒中治疗的医生检测MCA累及超过1/3的急性梗死的敏感性。组织纤溶酶原激活剂的研究表明，大面积梗死的早期迹象与不良预后之间存在关联。美国神经病学学会和美国心脏协会建议，如果存在大面积梗死的早期迹象，应避免进行溶栓治疗。
我们向3名学术神经放射科医生展示了25份扫描图像（正常、急性梗死和陈旧性梗死）。使用基于缺血性卒中急性非介入性治疗的阿替普酶溶栓（ATLANTIS）/CT峰会标准的评分表来确定MCA区域累及超过1/3的情况。25份扫描图像中的9份再次展示以评估评分者内可靠性。我们重新计算了我们之前研究的结果，在该研究中医生解读梗死扫描图像，现在根据神经放射科医生的判断将扫描图像指定为MCA累及超过1/3、累及不到1/3或正常。
所有3名神经放射科医生在64%的扫描图像上对无梗死、累及不到1/3的MCA和累及超过1/3的MCA达成了一致意见。对于累及超过1/3的MCA区域，神经放射科医生的重测一致性为96%。对于在被评为累及超过1/3的MCA的扫描图像中检测梗死存在情况，急诊科医生、神经科医生和普通放射科医生的总体敏感性为78%。
神经放射科医生在检测累及超过1/3的MCA梗死方面可达成中等程度的一致性。接受测试的急诊科医生、神经科医生和普通放射科医生在检测累及超过1/3的MCA急性梗死方面具备一定技能。然而，他们的表现并不能可靠地识别所有具有早期CT梗死迹象且溶栓治疗后脑出血风险增加的患者。
