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Reliability of Visual Assessment of Non-Contrast CT, CT Angiography Source Images and CT Perfusion in Patients with Suspected Ischemic Stroke
BACKGROUND AND PURPOSE: Good reliability of methods to assess the extent of ischemia in acute stroke is important for implementation in clinical practice, especially between observers with varying experience. Our aim was to determine inter- and intra-observer reliability of the 1/3 middle cerebral a...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792960/ https://www.ncbi.nlm.nih.gov/pubmed/24116061 http://dx.doi.org/10.1371/journal.pone.0075615 |
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author | van Seeters, Tom Biessels, Geert Jan Niesten, Joris M. van der Schaaf, Irene C. Dankbaar, Jan Willem Horsch, Alexander D. Mali, Willem P. T. M. Kappelle, L. Jaap van der Graaf, Yolanda Velthuis, Birgitta K. |
author_facet | van Seeters, Tom Biessels, Geert Jan Niesten, Joris M. van der Schaaf, Irene C. Dankbaar, Jan Willem Horsch, Alexander D. Mali, Willem P. T. M. Kappelle, L. Jaap van der Graaf, Yolanda Velthuis, Birgitta K. |
author_sort | van Seeters, Tom |
collection | PubMed |
description | BACKGROUND AND PURPOSE: Good reliability of methods to assess the extent of ischemia in acute stroke is important for implementation in clinical practice, especially between observers with varying experience. Our aim was to determine inter- and intra-observer reliability of the 1/3 middle cerebral artery (MCA) rule and the Alberta Stroke Program Early CT Score (ASPECTS) for different CT modalities in patients suspected of acute ischemic stroke. METHODS: We prospectively included 105 patients with acute neurological deficit due to suspected acute ischemic stroke within 9 hours after symptom onset. All patients underwent non-contrast CT, CT perfusion and CT angiography on admission. All images were evaluated twice for presence of ischemia, ischemia with >1/3 MCA involvement, and ASPECTS. Four observers evaluated twenty scans twice for intra-observer agreement. We used kappa statistics and intraclass correlation coefficient to calculate agreement. RESULTS: Inter-observer agreement for the 1/3 MCA rule and ASPECTS was fair to good for non-contrast CT, poor to good for CT angiography source images, but excellent for all CT perfusion maps (cerebral blood volume, mean transit time, and predicted penumbra and infarct maps). Intra-observer agreement for the 1/3 MCA rule and ASPECTS was poor to good for non-contrast CT, fair to moderate for CT angiography source images, and good to excellent for all CT perfusion maps. CONCLUSION: Between observers with a different level of experience, agreement on the radiological diagnosis of cerebral ischemia is much better for CT perfusion than for non-contrast CT and CT angiography source images, and therefore CT perfusion is a very reliable addition to standard stroke imaging. |
format | Online Article Text |
id | pubmed-3792960 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-37929602013-10-10 Reliability of Visual Assessment of Non-Contrast CT, CT Angiography Source Images and CT Perfusion in Patients with Suspected Ischemic Stroke van Seeters, Tom Biessels, Geert Jan Niesten, Joris M. van der Schaaf, Irene C. Dankbaar, Jan Willem Horsch, Alexander D. Mali, Willem P. T. M. Kappelle, L. Jaap van der Graaf, Yolanda Velthuis, Birgitta K. PLoS One Research Article BACKGROUND AND PURPOSE: Good reliability of methods to assess the extent of ischemia in acute stroke is important for implementation in clinical practice, especially between observers with varying experience. Our aim was to determine inter- and intra-observer reliability of the 1/3 middle cerebral artery (MCA) rule and the Alberta Stroke Program Early CT Score (ASPECTS) for different CT modalities in patients suspected of acute ischemic stroke. METHODS: We prospectively included 105 patients with acute neurological deficit due to suspected acute ischemic stroke within 9 hours after symptom onset. All patients underwent non-contrast CT, CT perfusion and CT angiography on admission. All images were evaluated twice for presence of ischemia, ischemia with >1/3 MCA involvement, and ASPECTS. Four observers evaluated twenty scans twice for intra-observer agreement. We used kappa statistics and intraclass correlation coefficient to calculate agreement. RESULTS: Inter-observer agreement for the 1/3 MCA rule and ASPECTS was fair to good for non-contrast CT, poor to good for CT angiography source images, but excellent for all CT perfusion maps (cerebral blood volume, mean transit time, and predicted penumbra and infarct maps). Intra-observer agreement for the 1/3 MCA rule and ASPECTS was poor to good for non-contrast CT, fair to moderate for CT angiography source images, and good to excellent for all CT perfusion maps. CONCLUSION: Between observers with a different level of experience, agreement on the radiological diagnosis of cerebral ischemia is much better for CT perfusion than for non-contrast CT and CT angiography source images, and therefore CT perfusion is a very reliable addition to standard stroke imaging. Public Library of Science 2013-10-08 /pmc/articles/PMC3792960/ /pubmed/24116061 http://dx.doi.org/10.1371/journal.pone.0075615 Text en © 2013 van Seeters et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article van Seeters, Tom Biessels, Geert Jan Niesten, Joris M. van der Schaaf, Irene C. Dankbaar, Jan Willem Horsch, Alexander D. Mali, Willem P. T. M. Kappelle, L. Jaap van der Graaf, Yolanda Velthuis, Birgitta K. Reliability of Visual Assessment of Non-Contrast CT, CT Angiography Source Images and CT Perfusion in Patients with Suspected Ischemic Stroke |
title | Reliability of Visual Assessment of Non-Contrast CT, CT Angiography Source Images and CT Perfusion in Patients with Suspected Ischemic Stroke |
title_full | Reliability of Visual Assessment of Non-Contrast CT, CT Angiography Source Images and CT Perfusion in Patients with Suspected Ischemic Stroke |
title_fullStr | Reliability of Visual Assessment of Non-Contrast CT, CT Angiography Source Images and CT Perfusion in Patients with Suspected Ischemic Stroke |
title_full_unstemmed | Reliability of Visual Assessment of Non-Contrast CT, CT Angiography Source Images and CT Perfusion in Patients with Suspected Ischemic Stroke |
title_short | Reliability of Visual Assessment of Non-Contrast CT, CT Angiography Source Images and CT Perfusion in Patients with Suspected Ischemic Stroke |
title_sort | reliability of visual assessment of non-contrast ct, ct angiography source images and ct perfusion in patients with suspected ischemic stroke |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792960/ https://www.ncbi.nlm.nih.gov/pubmed/24116061 http://dx.doi.org/10.1371/journal.pone.0075615 |
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