Department of Neuroradiology, Centre Hospitalier Sainte Anne, Paris, France.
Department of Interventional Neuroradiology, Hopital Universitaire Pitie Salpetriere, Paris, France.
J Neurointerv Surg. 2019 Apr;11(4):338-341. doi: 10.1136/neurintsurg-2018-014185. Epub 2018 Aug 21.
The adequacy of leptomeningeal collateral flow has a pivotal role in determining clinical outcome in acute ischemic stroke. The American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral score is among the most commonly used scales for measuring this flow. It is based on the extent and rate of retrograde collateral flow to the impaired territory on angiography.
To evaluate inter- and intraobserver agreementin angiographic leptomeningeal collateral flow assessment.
Thirty pretreatment angiogram video loops (frontal and lateral view), chosen from the randomized controlled trial THRombectomie des Artères CErebrales (THRACE), were sent for grading in an electronic file. 19 readers participated, including eight who had access to a training set before the first grading. 13 readers made a double evaluation, 3 months apart.
Overall agreement among the 19 observers was poor (κ = 0,16 ± 6,5.10 ), and not improved with prior training (κ = 0,14 ± 0,016). Grade 4 showed the poorest interobserver agreement (κ=0.18±0.002) while grades 0 and 1 were associated with the best results (κ=0.52±0.001 and κ=0.43±0.004, respectively). Interobserver agreement increased (κ = 0,27± 0,014) when a dichotomized score, 'poor collaterals' (score of 0, 1 or 2) versus 'good collaterals' (score of 3 or 4) was used. The intraobserver agreements varied between slight (κ=0.18±0.13) and substantial (κ=0.74±0.1), and were slightly improved with the dichotomized score (from κ=0.19±0.2 to κ=0.79±0.11).
Inter- and intraobserver agreement of collateral circulation grading using the ASITN/SIR score was poor, raising concerns about comparisons among publications. A simplified dichotomized judgment may be a more reproducible assessment when images are rated by the same observer(s) in randomized trials.
软脑膜侧支循环的充分性在决定急性缺血性脑卒中的临床转归方面起着关键作用。美国介入治疗和治疗神经放射学会/介入放射学会（ASITN/SIR）侧支评分是用于测量这种血流的最常用的评分之一。它基于血管造影上向受损区域逆行侧支血流的程度和速度。
评估血管造影软脑膜侧支循环评估的观察者间和观察者内一致性。
从随机对照试验 THRombectomie des Artères CErebrales（THRACE）中选择 30 个治疗前血管造影视频循环（额位和侧位视图），并以电子文件形式发送进行分级。19 名读者参与了评分，其中 8 名读者在第一次评分前可以访问培训集。13 名读者进行了双次评估，间隔 3 个月。
19 名观察者的总体一致性较差（κ=0.16±6.5.10），且预先培训并未改善一致性（κ=0.14±0.016）。第 4 级的观察者间一致性最差（κ=0.18±0.002），而第 0 级和第 1 级的结果最好（κ=0.52±0.001 和 κ=0.43±0.004）。当使用二分评分（“差侧支”[评分 0、1 或 2]与“好侧支”[评分 3 或 4]）时，观察者间一致性增加（κ=0.27±0.014）。观察者内一致性在轻微（κ=0.18±0.13）和明显（κ=0.74±0.1）之间变化，并且使用二分评分略有改善（从 κ=0.19±0.2 到 κ=0.79±0.11）。
使用 ASITN/SIR 评分评估侧支循环分级的观察者间和观察者内一致性较差，这引发了对出版物之间比较的关注。当同一观察者对图像进行评分时，简化的二分判断可能是更具重现性的评估。
