From the Department of Neurological Surgery (D.M.H., N.C.P., M.R.R., J.C.S.), Clinical Research Office (A.W.W.), Loyola University Stritch School of Medicine and Loyola University Medical Center, Maywood, Illinois
From the Department of Neurological Surgery (D.M.H., N.C.P., M.R.R., J.C.S.), Clinical Research Office (A.W.W.), Loyola University Stritch School of Medicine and Loyola University Medical Center, Maywood, Illinois.
AJNR Am J Neuroradiol. 2020 Aug;41(8):1441-1446. doi: 10.3174/ajnr.A6696. Epub 2020 Jul 23.
The modified TICI score is the benchmark for quantifying reperfusion after mechanical thrombectomy. There has been limited investigation into the reliability of this score. We aim to identify intra-rater and inter-rater reliability of the mTICI score among endovascular neurosurgeons.
Four independent endovascular neurosurgeons (raters) reviewed angiograms of 67 patients at 2 time points. κ statistics assessed inter- and intrarater reliability and compared raters'-versus-proceduralists' scores. Reliability was also assessed for occlusion location and by dichotomizing modified TICI scores (0-2a versus 2b-3).
Interrater reliability was moderate-to-substantial, weighted κ = 0.417-0.703, overall κ = 0.374 (< .001). The dichotomized modified TICI score had moderate-to-substantial interrater agreement, κ statistics = 0.468-0.715, overall κ = 0.582 (< .001). Intrarater reliability was moderate-to-almost perfect, weighted κ = 0.594-0.81. The dichotomized modified TICI score had substantial-to-almost perfect reliability, κ = 0.632-0.82. Proceduralists had fair-to-moderate agreement with raters, weighted κ = 0.348-0.574, and the dichotomized modified TICI score had fair-to-moderate agreement, κ = 0.365-0.544. When proceduralists and raters disagreed, proceduralists' scores were higher in 79.6% of cases. M1 followed by ICA occlusions had the highest agreement.
The modified TICI score is a practical metric for assessing reperfusion after mechanical thrombectomy, though not without limitations. Agreement improved when scores were dichotomized around the clinically relevant threshold of successful revascularization. Interrater reliability improved with time, suggesting that formal training of interventionalists may improve reporting reliability. Agreement of the modified TICI scale is best with M1 and ICA occlusion and becomes less reliable with more distal or posterior circulation occlusions. These findings should be considered when developing research trials.
改良的 TICI 评分是评估机械取栓后再灌注的基准。该评分的可靠性研究有限。我们旨在确定血管内神经外科医生对 mTICI 评分的内部和外部可靠性。
4 名独立的血管内神经外科医生（评估者）在 2 个时间点对 67 例患者的血管造影进行了回顾。κ 统计评估了内部和外部可靠性，并比较了评估者与术者的评分。还评估了闭塞位置和改良 TICI 评分（0-2a 与 2b-3）二分法的可靠性。
内部评估者间的可靠性为中等至高度，加权κ=0.417-0.703，总κ=0.374（<.001）。改良 TICI 评分的二分法具有中等至高度的内部评估者间一致性，κ 统计=0.468-0.715，总κ=0.582（<.001）。内部评估者间的可靠性为中等至近乎完美，加权κ=0.594-0.81。改良 TICI 评分的二分法具有高度至近乎完美的可靠性，κ=0.632-0.82。术者与评估者的一致性为中度至良好，加权κ=0.348-0.574，改良 TICI 评分的二分法具有中度至良好的一致性，κ=0.365-0.544。当术者和评估者意见不一致时，在 79.6%的情况下，术者的评分更高。M1 继 ICA 闭塞后具有最高的一致性。
改良的 TICI 评分是评估机械取栓后再灌注的实用指标，但并非没有局限性。当评分以与成功再血管化相关的临床相关阈值为界进行二分法时，一致性得到改善。随着时间的推移，内部评估者间的可靠性提高，这表明对介入医师进行正式培训可能会提高报告的可靠性。改良 TICI 量表的一致性在 M1 和 ICA 闭塞时最好，随着闭塞位置越远或越靠后，一致性越不可靠。在制定研究试验时应考虑这些发现。
