DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) Mismatch in Thrombectomy Candidates An Intrarater and Interrater Agreement Study

被引：44

作者：

Fahed, Robert ^{[1
]}

Lecler, Augustin ^{[2
]}

Sabben, Candice ^{[3
]}

Khoury, Naim ^{[5
]}

Ducroux, Celina ^{[1
]}

Chalumeau, Vanessa ^{[1
]}

Botta, Daniele ^{[1
]}

Kalsoum, Erwah ^{[6
]}

Boisseau, William ^{[1
]}

Duron, Loic ^{[2
]}

Cabral, Dominique ^{[2
]}

Koskas, Patricia ^{[2
]}

Benaissa, Azzedine ^{[6
]}

Koulakian, Hasmik ^{[7
]}

Obadia, Michael ^{[3
]}

Maier, Benjamin ^{[1
]}

Weisenburger-Lile, David ^{[3
]}

Lapergue, Bertrand ^{[8
]}

Wang, Adrien ^{[8
]}

Redjem, Hocine ^{[1
]}

Ciccio, Gabriele ^{[1
]}

Smajda, Stanislas ^{[1
]}

Desilles, Jean-Philippe ^{[1
]}

Mazighi, Mikael ^{[1
]}

Ben Maacha, Malek ^{[4
]}

Akkari, Ines ^{[4
]}

Zuber, Kevin ^{[4
]}

Blanc, Raphael ^{[1
]}

Raymond, Jean ^{[9
]}

Piotin, Michel ^{[1
]}

机构：

[1] Fdn Rothschild Hosp, Intervent Neuroradiol Unit, Paris, France

[2] Fdn Rothschild Hosp, Diagnost Radiol Unit, Paris, France

[3] Fdn Rothschild Hosp, Neurovasc Unit, Paris, France

[4] Fdn Rothschild Hosp, Res & Biostat Unit, Paris, France

[5] HSHS St Johns Hosp, HSHS Neurosci Ctr, Springfield, IL USA

[6] Henri Mondor Hosp, Neuroradiol Unit, Creteil, France

[7] Cochin Hosp, Radiol Unit, Paris, France

[8] Foch Hosp, Neurovasc Unit, Suresnes, France

[9] Notre Dame Hosp, CHUM Res Ctr, Intervent Neuroradiol Res Lab, Montreal, PQ, Canada

来源：

STROKE | 2018年 / 49卷 / 01期

关键词：

Alberta; magnetic resonance imaging; neurologists; reading; thrombectomy; ACUTE ISCHEMIC-STROKE; MECHANICAL THROMBECTOMY; LOW KAPPA; IDENTIFICATION; RELIABILITY; MULTICENTER; REPERFUSION; PARADOXES; THERAPY; TRIAL;

D O I：

10.1161/STROKEAHA.117.019508

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose-We aimed to study the intrarater and interrater agreement of clinicians attributing DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) mismatch in patients with acute ischemic stroke referred for mechanical thrombectomy. Methods-Eighteen raters independently scored anonymized magnetic resonance imaging scans of 30 participants from a multicentre thrombectomy trial, in 2 different reading sessions. Agreement was measured using Fleiss kappa and Cohen kappa statistics. Results-Interrater agreement for DWI-ASPECTS was slight (kappa=0.17 [0.14-0.21]). Four raters (22.2%) had a substantial (or higher) intrarater agreement. Dichotomization of the DWI-ASPECTS (0-5 versus 6-10 or 0-6 versus 7-10) increased the interrater agreement to a substantial level (kappa=0.62 [0.48-0.75] and 0.68 [0.55-0.79], respectively) and more raters reached a substantial (or higher) intrarater agreement (17/18 raters [94.4%]). Interrater agreement for DWI-FLAIR mismatch was moderate (kappa=0.43 [0.33-0.57]); 11 raters (61.1%) reached a substantial (or higher) intrarater agreement. Conclusions-Agreement between clinicians assessing DWI-ASPECTS and DWI-FLAIR mismatch may not be sufficient to make repeatable clinical decisions in mechanical thrombectomy. The dichotomization of the DWI-ASPECTS (0-5 versus 0-6 or 0-6 versus 7-10) improved interrater and intrarater agreement, however, its relevance for patients selection for mechanical thrombectomy needs to be validated in a randomized trial.

引用

页码：223 / +

页数：10

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