Bar Michal, Kral Jiri, Jonszta Tomas, Marcian Vaclav, Kuliha Martin, Mikulik Robert
1 Comprehensive Stroke Centre, University Hospital Ostrava, Ostrava, Czech Republic.
2 Department of Neurology and Psychiatry, Faculty of Medicine, University Ostrava, Czech Republic.
Br J Radiol. 2017 Mar;90(1071):20160670. doi: 10.1259/bjr.20160670. Epub 2017 Jan 24.
The diagnosis of arterial occlusion has a considerable impact on the indication of mechanical thrombectomy, and CT angiography (CTA) is recommended in the management of acute stroke. The goal of the present study is to assess the interrater agreement in the diagnosis of occlusion of intracranial arteries on CTA between a neuroradiologist and neurologists.
CTA images of 75 acute stroke patients were evaluated for occlusion of intracranial arteries by an experienced interventional neuroradiologist, and stroke and general neurologists.
75 patients who were treated by intravenous thrombolysis were enrolled in the study. CTA images were available for all 75 patients (34 females; mean age ± SD, 72 ± 14 years; National Institutes of Health Stroke Scale 10; median 8-14; and Alberta Stroke Program Early CT mean 9.7). The agreement between the neuroradiologist and neurologists in evaluation of intracranial artery occlusion was as follows: occlusion of the middle cerebral artery segment M1: observer agreement 77%, kappa (κ) = 0.61 and middle cerebral artery M2: observer agreement 77%, κ 0.48; internal carotid artery: observer agreement 92%, κ 0.84; T occlusion: observer agreement 90.0%, κ 0.33; posterior cerebral artery segments P1 and P2: observer agreement 98%, κ 0.97; basilar artery: observer agreement 96%, κ 0.92; and vertebral artery segment V4: observer agreement 88%, κ 0.48.
Interrater agreement of CTA evaluation of occlusion between the neurologists and the neuroradiologist was very strong. The ability of the trained neurologists to read an intracranial large vessel occlusion correctly may improve the door-to-needle times in acute stroke. Advances in knowledge: In this study, the neurologists were able to recognize occlusion of intracranial arteries. This could accelerate the management of acute stroke care.
动脉闭塞的诊断对机械取栓的适应证有相当大的影响，在急性卒中的管理中推荐使用CT血管造影（CTA）。本研究的目的是评估神经放射科医生和神经科医生在CTA上对颅内动脉闭塞诊断的观察者间一致性。
由一位经验丰富的介入神经放射科医生以及卒中专科和普通神经科医生对75例急性卒中患者的CTA图像进行颅内动脉闭塞评估。
75例接受静脉溶栓治疗的患者纳入本研究。所有75例患者均有CTA图像（34例女性；平均年龄±标准差，72±14岁；美国国立卫生研究院卒中量表评分为10分；中位数8 - 14分；阿尔伯塔卒中项目早期CT评分平均为9.7分）。神经放射科医生和神经科医生在评估颅内动脉闭塞方面的一致性如下：大脑中动脉M1段闭塞：观察者一致性为77%，kappa（κ）=0.61；大脑中动脉M2段闭塞：观察者一致性为77%，κ=0.48；颈内动脉闭塞：观察者一致性为92%，κ=0.84；T形闭塞：观察者一致性为90.0%，κ=0.33；大脑后动脉P1和P2段闭塞：观察者一致性为98%，κ=0.97；基底动脉闭塞：观察者一致性为96%，κ=0.92；椎动脉V4段闭塞：观察者一致性为88%，κ=0.48。
神经科医生和神经放射科医生在CTA评估闭塞方面的观察者间一致性非常高。经过培训的神经科医生正确解读颅内大血管闭塞的能力可能会缩短急性卒中的门到针时间。知识进展：在本研究中，神经科医生能够识别颅内动脉闭塞。这可以加快急性卒中的治疗管理。
