Madaelil Thomas P, Grossberg Jonathan A, Nogueira Raul G, Anderson Aaron, Barreira Clara, Frankel Michael, Haussen Diogo C
Departments of Neurology and Neurosurgery, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, United States.
Front Neurol. 2019 Mar 12;10:220. doi: 10.3389/fneur.2019.00220. eCollection 2019.
Carotid web (CaW) is an underrecognized cause of cryptogenic stroke in young patients. The optimal imaging for CaW is unknown. We aim to evaluate the diagnostic accuracy of diverse imaging modalities for the diagnosis of CaW. Retrospective analysis of institutional neurovascular database was performed to identify patients with multimodal (CT angiogram-CTA, digital subtraction angiogram-DSA, and/or ultrasound-US) imaging diagnosis of CaW or atherosclerosis. Baseline clinical demographics were recorded. Blinded image analysis was performed for each imaging modality by separate readers. Discrepancies were settled by consensus. Two-sided Cohen's Kappa (κ) coefficient was used to evaluate the inter-rater agreement for the etiological diagnosis between imaging modalities. Thirty patients/60 carotids were evaluated by CTA and 55 carotids were included. Patients with symptomatic CaW ( = 20), compared to individuals with atherosclerosis ( = 10), were younger (49 ± 9 vs. 60 ± 8 years; < 0.01), more commonly female (75% vs. 30%; = 0.01), and less frequently presented vascular risk factors: Hypertension (40% vs. 100%; < 0.01), hyperlipidemia (0% vs. 50%; < 0.01), diabetes (10% vs. 40%; = 0.05), and smoking (5% vs. 70%; < 0.01). High inter-rater correlation strength existed for CTA ( = 55; κ = 0.88; < 0.0001) and DSA ( = 28; κ = 0.86, < 0.0001) readers for lesion diagnosis while US inter-rater agreement was lower (κ = 0.553; = 0.001). Across modalities CTA and DSA shared very high strength of agreement (κ = 0.92; < 0.0001), compared to a less pronounced agreement between US and CTA (κ = 0.553; = 0.001). The strength of correlation between DSA-CTA was significantly more robust as compared to US-CTA (Z = 3.58; = 0.0003). CTA and DSA demonstrated comparable and superior performance as compared to US in the diagnosis of CaW.
颈动脉嵴（CaW）是年轻患者不明原因卒中的一个未被充分认识的病因。目前尚不清楚针对CaW的最佳影像学检查方法。我们旨在评估多种影像学检查方法对CaW诊断的准确性。对机构神经血管数据库进行回顾性分析，以确定经多模态（CT血管造影-CTA、数字减影血管造影-DSA和/或超声-US）影像学诊断为CaW或动脉粥样硬化的患者。记录基线临床人口统计学数据。由不同的阅片者对每种影像学检查方法进行盲法图像分析。分歧通过协商解决。使用双侧Cohen's Kappa（κ）系数评估不同影像学检查方法之间病因诊断的阅片者间一致性。通过CTA评估了30例患者/60条颈动脉，纳入了55条颈动脉。有症状的CaW患者（n = 20）与动脉粥样硬化患者（n = 10）相比，年龄更小（49±9岁 vs. 60±8岁；P < 0.01），女性更常见（75% vs. 30%；P = 0.01），出现血管危险因素的频率更低：高血压（40% vs. 100%；P < 0.01）、高脂血症（0% vs. 50%；P < 0.01）、糖尿病（10% vs. 40%；P = 0.05）和吸烟（5% vs. 70%；P < 0.01）。CTA（n = 55；κ = 0.88；P < 0.0001）和DSA（n = 28；κ = 0.86，P < 0.0001）阅片者在病变诊断方面存在高度的阅片者间相关性，而US的阅片者间一致性较低（κ = 0.553；P = 0.001）。在不同检查方法中，CTA和DSA的一致性非常高（κ = 0.92；P < 0.0001），相比之下，US与CTA之间的一致性则不太明显（κ = 0.553；P = 0.001）。DSA与CTA之间的相关性强度明显高于US与CTA之间的相关性（Z = 3.58；P = 0.0003）。在CaW的诊断中，CTA和DSA表现出与US相当且更优的性能。
