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Interrater Agreement and Detection Accuracy for Medium-Vessel Occlusions Using Single-Phase and Multiphase CT

J M Ospel1,2, F Bala1, R V McDonough1

  • 1From the Department of Diagnostic Imaging (J.M.O., F.B., R.V.M., N.K., W.Q., B.K.M., M.G.).

AJNR. American Journal of Neuroradiology
|November 26, 2021
PubMed
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Multiphase CT angiography significantly improves the detection accuracy and interrater agreement for medium-vessel occlusions in acute ischemic stroke compared to single-phase CTA. This enhanced imaging technique aids in better diagnosis and treatment planning.

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Area of Science:

  • Neuroradiology
  • Vascular Imaging
  • Stroke Diagnosis

Background:

  • Accurate detection of medium-vessel occlusions is crucial for acute ischemic stroke diagnosis and treatment.
  • Medium-vessel occlusions present detection challenges, particularly for less experienced readers.
  • Computed Tomography Angiography (CTA) is a key imaging modality for stroke assessment.

Purpose of the Study:

  • To evaluate the accuracy and interrater agreement of detecting medium-vessel occlusions.
  • To compare the performance of single-phase CTA versus multiphase CTA for this detection.
  • To assess the impact of reader experience on detection accuracy.

Main Methods:

  • Retrospective analysis of 120 acute ischemic stroke patient CTAs (single-phase and multiphase).
  • Three readers with varying experience levels assessed occlusions (no occlusion, large-vessel, medium-vessel).
  • Interrater agreement calculated using Fleiss κ; accuracy determined via classification tables.

Main Results:

  • Interrater agreement for occlusion type improved from moderate (κ=0.58) with single-phase CTA to almost perfect (κ=0.81) with multiphase CTA.
  • Accuracy for medium-vessel occlusion detection increased substantially: 57-61% with single-phase CTA to 86-89% with multiphase CTA.
  • Interrater agreement for detailed occlusion sites was also higher with multiphase CTA (κ=0.71) vs. single-phase CTA (κ=0.55).

Conclusions:

  • Multiphase CTA demonstrates significantly higher accuracy and interrater agreement for medium-vessel occlusion detection compared to single-phase CTA.
  • Multiphase CTA is a valuable tool for improving the assessment of medium-vessel occlusion stroke.
  • The findings suggest a potential improvement in stroke diagnosis and treatment initiation.