Kim Joon-Tae, Heo Suk-Hee, Lee Ji Sung, Park Myeong-Ho, Oh Dong-Seok, Choi Kang-Ho, Kim Ihn-Gyu, Ha Yeon Soo, Chang Hyuk, Choo In Sung, Ahn Seong Hwan, Jeong Seul-Ki, Shin Byoung-Soo, Park Man-Seok, Cho Ki-Hyun
Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea.
Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
PLoS One. 2014 Jun 6;9(6):e99261. doi: 10.1371/journal.pone.0099261. eCollection 2014.
There has still been lack of evidence for definite imaging criteria of intra-arterial revascularization (IAR). Therefore, IAR selection is left largely to individual clinicians. In this study, we sought to investigate the overall agreement of IAR selection among different stroke clinicians and factors associated with good agreement of IAR selection.
From the prospectively registered data base of a tertiary hospital, we identified consecutive patients with acute ischemic stroke. IAR selection based on the provided magnetic resonance imaging (MRI) results and clinical information were independently performed by 5 independent stroke physicians currently working at 4 different university hospitals. MRI results were also reviewed by 2 independent experienced neurologists blinded to clinical data and physicians' IAR selection. The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was calculated on initial DWI and MTT. We arbitrarily used ASPECTS differences between DWI and MTT (D-M ASPECTS) to quantitatively evaluate mismatch.
The overall interobserver agreement of IAR selection was fair (kappa = 0.398). In patients with DWI-ASPECTS >6, interobserver agreement was moderate to substantial (0.398-0.620). In patients with D-M ASPECTS >4, interobserver agreement was moderate to almost perfect (0.532-1.000). Patients with higher DWI or D-M ASPECTS had better agreement of IAR selection.
Our study showed that DWI-ASPSECTS >6 and D-M ASPECTS >4 had moderate to substantial agreement of IAR selection among different stroke physicians. However, there is still poor agreement as to whether IAR should not be performed in patients with lower DWI and D-M ASPECTS.
对于动脉内血运重建（IAR）的明确影像学标准，目前仍缺乏证据。因此，IAR的选择很大程度上取决于临床医生个人。在本研究中，我们试图调查不同卒中临床医生在IAR选择上的总体一致性，以及与IAR选择良好一致性相关的因素。
从一家三级医院的前瞻性注册数据库中，我们确定了连续的急性缺血性卒中患者。由目前在4家不同大学医院工作的5名独立的卒中医生，根据提供的磁共振成像（MRI）结果和临床信息独立进行IAR选择。2名对临床数据和医生的IAR选择不知情的独立经验丰富的神经科医生也对MRI结果进行了审查。根据初始弥散加权成像（DWI）和灌注加权成像（MTT）计算阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）。我们任意使用DWI和MTT之间的ASPECTS差异（D-M ASPECTS）来定量评估不匹配情况。
IAR选择的观察者间总体一致性一般（kappa = 0.398）。在DWI-ASPECTS>6的患者中，观察者间一致性为中等至高度（0.398 - 0.620）。在D-M ASPECTS>4的患者中，观察者间一致性为中等至几乎完全一致（0.532 - 1.000）。DWI或D-M ASPECTS较高的患者在IAR选择上的一致性更好。
我们的研究表明，DWI-ASPSECTS>6和D-M ASPECTS>4在不同卒中医生的IAR选择上具有中等至高度的一致性。然而，对于DWI和D-M ASPECTS较低的患者是否不应进行IAR，仍存在较差的一致性。
