Clinical uncertainty in large vessel occlusion ischemic stroke: does automated perfusion imaging make a difference? An intra-rater and inter-rater agreement study

被引：0

作者：

Diestro, Jose Danilo Bengzon ^{[1
,2
,3
,4
]}

Fahed, Robert ^{[5
]}

Omar, Abdelsimar Tan ^{[6
]}

Hawkes, Christine ^{[7
]}

Hendriks, Eef J. ^{[8
]}

Enriquez, Clare ^{[7
]}

Eesa, Muneer ^{[9
]}

Stotts, Grant ^{[5
]}

Lee, Hubert ^{[10
]}

Nagendra, Shashank ^{[11
]}

Poppe, Alexandre ^{[12
]}

Ducroux, Celina ^{[5
]}

Lim, Timothy ^{[13
]}

Narvacan, Karl ^{[14
]}

Rizzuto, Michael ^{[15
]}

Alfalahi, Afra ^{[4
]}

Nishi, Hidehisa ^{[4
,16
]}

Sarma, Pragyan ^{[4
]}

Itsekson Hayosh, Ze'ev ^{[4
,8
]}

Ignacio, Katrina ^{[11
]}

Boisseau, William ^{[17
]}

Pimenta Ribeiro Pontes Almeida, Eduardo ^{[18
]}

Benomar, Anass ^{[19
]}

Almekhlafi, Mohammed A. ^{[20
,21
,22
,23
]}

Milot, Genvieve ^{[24
]}

Deshmukh, Aviraj ^{[25
]}

Kishore, Kislay ^{[6
]}

Tampieri, Donatella ^{[26
]}

Wang, Jeffrey ^{[2
]}

Srivastava, Abhilekh ^{[27
]}

Roy, Daniel ^{[28
]}

Carpani, Federico ^{[29
]}

Kashani, Nima ^{[30
]}

Candale-Radu, Claudia ^{[31
]}

Singh, Nishita ^{[31
]}

Bres Bullrich, Maria ^{[32
]}

Sarmiento, Robert ^{[33
]}

Muir, Ryan T. ^{[11
]}

Parra-Farinas, Carmen ^{[34
,35
]}

Reiter, Stephanie ^{[7
]}

Deschaintre, Yan ^{[12
]}

Singh, Ravinder-Jeet ^{[25
]}

Bodani, Vivek ^{[8
]}

Katsanos, Aristeidis ^{[27
]}

Agid, Ronit ^{[8
]}

Zafar, Atif ^{[2
]}

Pereira, Vitor M. ^{[3
,4
,36
]}

Spears, Julian ^{[36
]}

Marotta, Thomas R. ^{[3
,4
]}

Djiadeu, Pascal ^{[1
,37
]}

机构：

[1] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[2] Univ Toronto, Dept Med, Divison Neurol, St Michaels Hosp Unity Hlth Toronto, Toronto, ON, Canada

[3] St Michaels Hosp, Unity Hlth Toronto, Li Ka Shing Knowledge Inst, Toronto, ON, Canada

[4] Univ Toronto, Dept Med Imaging, Div Diagnost & Therapeut Neuroradiol, Unity Hlth Toronto,St Michaels Hosp, Toronto, ON, Canada

[5] Univ Ottawa, Ottawa Hosp, Dept Med, Div Neurol,Ottawa Hosp Res Inst, Ottawa, ON, Canada

[6] McMaster Univ, Dept Surg, Div Neurosurg, Hamilton, ON, Canada

[7] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Med, Div Neurol, Toronto, ON, Canada

[8] Univ Toronto, Toronto Western Hosp, Univ Hlth Network, Div Intervent Neuroradiol,Joint Dept Med Imaging J, Toronto, ON, Canada

[9] Univ Calgary, Dept Radiol, Calgary, AB, Canada

[10] Trillium Hlth Partners, Div Neurointervent Neuroradiol, Div Neurosurg, Mississauga, ON L5M 2N1, Canada

[11] Univ Calgary, Cumming Sch Med, Dept Clin Neurosci, Calgary, AB, Canada

[12] Univ Montreal, Fac Med, Dept Neurosci, Montreal, PQ, Canada

[13] Univ Toronto, St Michaels Hosp, Dept Med Imaging, Div Diagnost Neuroradiol,Unity Hlth, Toronto, ON, Canada

[14] Univ Toronto, St Michaels Hosp, Unity Hlth Toronto, Dept Med Imaging, Toronto, ON, Canada

[15] Univ British Columbia, Vancouver Gen Hosp, Dept Surg, Div Neurosurg, Vancouver, BC, Canada

[16] Koseikai Takeda Hosp, Dept Neurosurg, Kyoto, Japan

[17] Fdn Rothschild Hosp, Dept Intervent Neuroradiol, Paris, France

[18] Univ Hlth Network, Toronto Gen Hosp, Toronto, ON, Canada

[19] Ctr Hosp Univ Montreal, Dept Radiol, Montreal, PQ, Canada

[20] Univ Calgary, Hotchkiss Brain Inst, Dept Clin Neurosci, Calgary, AB, Canada

[21] Univ Calgary, Hotchkiss Brain Inst, Dept Radiol, Calgary, AB, Canada

[22] Univ Calgary, Hotchkiss Brain Inst, Dept Community Hlth Sci, Calgary, AB, Canada

[23] Univ Calgary, OBrien Inst Publ Hlth, Cumming Sch Med, Calgary, AB, Canada

[24] Univ Laval, Ctr Hosp Quebec, Dept Surg Neurosurg, Laval, PQ, Canada

[25] Northern Ontario Sch Med Univ, Div Clin Sci, Hlth Sci North, Sudbury, ON, Canada

[26] Queens Univ, Kingston Hlth Sci Ctr, Dept Radiol, Kingston, ON, Canada

[27] McMaster Univ, Hamilton Gen Hosp, Dept Med, Div Neurol, Hamilton, ON, Canada

[28] Univ Montreal, Dept Radiol Radiooncol & Med Nucl, Montreal, PQ, Canada

[29] Univ Toronto, Univ Hlth Network, Toronto Western Hosp, Div Neurol,Dept Med, Toronto, ON, Canada

[30] Univ Saskatchewan, Royal Univ Hosp, Dept Med Imaging, Saskatoon, SK, Canada

[31] Univ Manitoba, Hlth Sci Ctr, Dept Internal Med, Div Neurol, Winnipeg, MB, Canada

[32] Western Univ, Schulich Sch Med & Dent, Dept Clin Neurol Sci, London, ON, Canada

[33] Univ British Columbia, Vancouver Gen Hosp, Dept Med, Div Neurol, Vancouver, BC, Canada

[34] Univ Toronto, Hosp Sick Children, Dept Diagnost & Intervent Radiol, Div Neuroradiol, Toronto, ON, Canada

[35] Univ Toronto, Hosp Sick Children, Dept Diagnost & Intervent Radiol, Div Neurointervent, Toronto, ON, Canada

[36] Univ Toronto, St Michaels Hosp, Unity Hlth Toronto, Div Neurosurg,Dept Surg, Toronto, ON, Canada

[37] McMaster Univ, Dept Global Hlth, Hamilton, ON, Canada

[38] McMaster Univ, Dept Surg, Hamilton, ON, Canada

来源：

JOURNAL OF NEUROINTERVENTIONAL SURGERY | 2025年 / 17卷 / 02期

关键词：

Stroke; Thrombectomy; ENDOVASCULAR TREATMENT; LOW KAPPA; CT; THROMBECTOMY; RELIABILITY; GUIDELINES; SCORE;

D O I：

10.1136/jnis-2023-021429

中图分类号：

R445 [影像诊断学];

学科分类号：

100207 ;

摘要：

Background Limited research exists regarding the impact of neuroimaging on endovascular thrombectomy (EVT) decisions for late-window cases of large vessel occlusion (LVO) stroke.Objective T0 assess whether perfusion CT imaging: (1) alters the proportion of recommendations for EVT, and (2) enhances the reliability of EVT decision-making compared with non-contrast CT and CT angiography.Methods We conducted a survey using 30 patients drawn from an institutional database of 3144 acute stroke cases. These were presented to 29 Canadian physicians with and without perfusion imaging. We used non-overlapping 95% confidence intervals and difference in agreement classification as criteria to suggest a difference between the Gwet AC1 statistics (kappa G).Results The percentage of EVT recommendations differed by 1.1% with or without perfusion imaging. Individual decisions changed in 21.4% of cases (11.3% against EVT and 10.1% in favor). Inter-rater agreement (kappa G) among the 29 raters was similar between non-perfusion and perfusion CT neuroimaging (kappa G=0.487; 95% CI 0.327 to 0.647 and kappa G=0.552; 95% CI 0.430 to 0.675). The 95% CIs overlapped with moderate agreement in both. Intra-rater agreement exhibited overlapping 95% CIs for all 28 raters. kappa G was either substantial or excellent (0.81-1) for 71.4% (20/28) of raters in both groups.Conclusions Despite the minimal difference in overall EVT recommendations with either neuroimaging protocol one in five decisions changed with perfusion imaging. Regarding agreement we found that the use of automated CT perfusion images does not significantly impact the reliability of EVT decisions for patients with late-window LVO.

引用

页码：192 / 199

页数：8

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