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Updated: Mar 8, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Interrater variability for CT angiography evaluation between neurologists and neuroradiologist in acute stroke
Michal Bar1,2, Jiri Kral1,3, Tomas Jonszta4
11 Comprehensive Stroke Centre, University Hospital Ostrava, Ostrava, Czech Republic.
Insights
Neurologists demonstrated strong agreement with neuroradiologists in identifying intracranial artery occlusions using CT angiography (CTA). This accurate diagnosis of large vessel occlusion can expedite acute stroke treatment.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- CT angiography (CTA) is crucial for diagnosing arterial occlusion in acute stroke management.
- Accurate diagnosis impacts mechanical thrombectomy indications.
Purpose of the Study:
- To assess interrater agreement in diagnosing intracranial artery occlusions on CTA.
- Compare diagnoses between a neuroradiologist and neurologists.
Main Methods:
- CTA images from 75 acute stroke patients were reviewed.
- Evaluations were performed by an interventional neuroradiologist and stroke/general neurologists.
Main Results:
- High agreement was observed for internal carotid artery (92%, κ=0.84) and basilar artery (96%, κ=0.92) occlusions.
- Strong agreement (κ=0.97) was found for posterior cerebral artery segments P1 and P2.
- Moderate agreement was noted for middle cerebral artery M1/M2 and vertebral artery V4 occlusions.
Conclusions:
- Interrater agreement between neurologists and neuroradiologists for CTA evaluation of intracranial artery occlusion is very strong.
- Trained neurologists can accurately identify large vessel occlusions, potentially improving door-to-needle times in acute stroke care.
Objective:
The diagnosis of arterial occlusion has a considerable impact on the indication of mechanical thrombectomy, and CT angiography (CTA) is recommended in the management of acute stroke. The goal of the present study is to assess the interrater agreement in the diagnosis of occlusion of intracranial arteries on CTA between a neuroradiologist and neurologists.
Methods:
CTA images of 75 acute stroke patients were evaluated for occlusion of intracranial arteries by an experienced interventional neuroradiologist, and stroke and general neurologists.
Results:
75 patients who were treated by intravenous thrombolysis were enrolled in the study. CTA images were available for all 75 patients (34 females; mean age ± SD, 72 ± 14 years; National Institutes of Health Stroke Scale 10; median 8-14; and Alberta Stroke Program Early CT mean 9.7). The agreement between the neuroradiologist and neurologists in evaluation of intracranial artery occlusion was as follows: occlusion of the middle cerebral artery segment M1: observer agreement 77%, kappa (κ) = 0.61 and middle cerebral artery M2: observer agreement 77%, κ 0.48; internal carotid artery: observer agreement 92%, κ 0.84; T occlusion: observer agreement 90.0%, κ 0.33; posterior cerebral artery segments P1 and P2: observer agreement 98%, κ 0.97; basilar artery: observer agreement 96%, κ 0.92; and vertebral artery segment V4: observer agreement 88%, κ 0.48.
Conclusion:
Interrater agreement of CTA evaluation of occlusion between the neurologists and the neuroradiologist was very strong. The ability of the trained neurologists to read an intracranial large vessel occlusion correctly may improve the door-to-needle times in acute stroke. Advances in knowledge: In this study, the neurologists were able to recognize occlusion of intracranial arteries. This could accelerate the management of acute stroke care.
