Cervical Internal Carotid Occlusion versus Pseudo-occlusion at CT Angiography in the Context of Acute Stroke: An Accuracy, Interobserver, and Intraobserver Agreement Study
- 1 March 2018
- journal article
- research article
- Published by Radiological Society of North America (RSNA) in Radiology
- Vol. 286 (3), 1008-1015
- https://doi.org/10.1148/radiol.2017170681
Abstract
To evaluate the diagnostic accuracy and reliability of computed tomographic (CT) angiography to distinguish true cervical internal carotid artery (ICA) occlusion from pseudo-occlusion (defined as an isolated intracranial thrombus that impedes ascending blood flow) in the context of acute stroke. This was a retrospective study of patients who underwent thrombectomy with preprocedural CT angiography that helps to demonstrate a lack of attenuation in the cervical ICA on the symptomatic side (24 men and 13 women; mean age, 63 years; age range, 30–86 years). Seven readers, including five neuroradiologists and two interventional neuroradiology fellows, independently reviewed the CT angiography images to assess whether there was true cervical ICA occlusion. Their results were compared with digital subtraction angiography (DSA) as the reference standard. Sensitivity and specificity for detecting true occlusion as well as accuracy and diagnostic odds ratio were calculated, with inter- and intraobserver κ statistics. Cervical ICA pseudo-occlusion occurred in 12 of 37 patients (32.4%) with nonattenuation of the cervical ICA on the symptomatic side. Interobserver agreement coefficients did not reach the substantial value of 0.61 for either pairs or groups of readers. The cohort’s average sensitivity and specificity was 68% (95% confidence interval [CI]: 59%, 76%) and 75% (95% CI: 71%, 80%), respectively, with a diagnostic odds ratio of 8 (95% CI: 3, 18) and only fair interobserver agreement (κ = 0.32; 95% CI: 0.16, 0.47). In the context of acute ischemic stroke with ipsilateral ICA nonattenuation at single-phase CT angiography, even specialized radiologists may not reliably distinguish true cervical occlusion from pseudo-occlusion. © RSNA, 2017 Online supplemental material is available for this article.This publication has 26 references indexed in Scilit:
- Carotid pseudo-occlusion on CTA in patients with acute ischemic stroke: A concerning observationClinical Neurology and Neurosurgery, 2013
- Pseudo-occlusion of the extracranial carotid artery caused by intracranial carotid artery stenosisNeurological Sciences, 2011
- Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposedJournal of Clinical Epidemiology, 2011
- Sixty-Four-Section Multidetector CT Angiography of Carotid Arteries: A Systematic Analysis of Image Quality and ArtifactsAmerican Journal of Neuroradiology, 2009
- Early Recanalization After Intravenous Administration of Recombinant Tissue Plasminogen Activator as Assessed by Pre- and Post-Thrombolytic Angiography in Acute Ischemic Stroke PatientsStroke, 2007
- Tandem Internal Carotid Artery/Middle Cerebral Artery OcclusionStroke, 2006
- Multi-Slice CT Angiography in Diagnosing Total Versus Near Occlusions of the Internal Carotid ArteryStroke, 2004
- Bias, prevalence and kappaJournal of Clinical Epidemiology, 1993
- Measuring nominal scale agreement among many raters.Psychological Bulletin, 1971