Detection of emergent large vessel occlusion stroke with CT angiography is high across all levels of radiology training and grayscale viewing methods
- 31 March 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Radiology
- Vol. 30 (8), 4447-4453
- https://doi.org/10.1007/s00330-020-06814-9
Abstract
Objectives CT angiography (CTA) is essential in acute stroke to detect emergent large vessel occlusions (ELVO) and must be interpreted by radiologists with and without subspecialized training. Additionally, grayscale inversion has been suggested to improve diagnostic accuracy in other radiology applications. This study examines diagnostic performance in ELVO detection between neuroradiologists, non-neuroradiologists, and radiology residents using standard and grayscale inversion viewing methods. Methods A random, counterbalanced experimental design was used, where 18 radiologists with varying experiences interpreted the same patient images with and without grayscale inversion. Confirmed positive and negative ELVO cases were randomly ordered using a balanced design. Sensitivity, specificity, positive and negative predictive values as well as confidence, subjective assessment of image quality, time to ELVO detection, and overall interpretation time were examined between grayscale inversion (on/off) by experience level using generalized mixed modeling assuming a binary, negative binomial, and binomial distributions, respectively. Results All groups of radiologists had high sensitivity and specificity for ELVO detection (all > .94). Neuroradiologists were faster than non-neuroradiologists and residents in interpretation time, with a mean of 47 s to detect ELVO, as compared with 59 and 74 s, respectively. Residents were subjectively less confident than attending physicians. With respect to grayscale inversion, no differences were observed between groups with grayscale inversion vs. standard viewing for diagnostic performance (p = 0.30), detection time (p = .45), overall interpretation time (p = .97), and confidence (p = .20). Conclusions Diagnostic performance in ELVO detection with CTA was high across all levels of radiologist training level. Grayscale inversion offered no significant detection advantage. Key Points • Stroke is an acute vascular syndrome that requires acute vascular imaging. • Proximal large vessel occlusions can be identified quickly and accurately by radiologists across all training levels. • Grayscale inversion demonstrated minimal detectable benefit in the detection of proximal large vessel occlusions.This publication has 26 references indexed in Scilit:
- A Randomized Trial of Intraarterial Treatment for Acute Ischemic StrokeThe New England Journal of Medicine, 2015
- Stroke Severity and Incidence of Acute Large Vessel Occlusions in Patients with Hyper-Acute Cerebral Ischemia: Results from a Prospective Cohort Study Based on CT-Angiography (CTA)International Journal of Stroke, 2014
- Diagnostic Yield of Emergency Department Arch-to-Vertex CT Angiography in Patients with Suspected Acute StrokeAmerican Journal of Neuroradiology, 2014
- Positive display polarity is advantageous for both younger and older adultsErgonomics, 2013
- National Institutes of Health Stroke Scale Score and Vessel Occlusion in 2152 Patients With Acute Ischemic StrokeStroke, 2013
- Gray-scale inversion radiographic display for the detection of pulmonary nodules on chest radiographsClinical Imaging, 2012
- Transfer Delay Is a Major Factor Limiting the Use of Intra-Arterial Treatment in Acute Ischemic StrokeStroke, 2011
- Effect of display factors on Chinese reading times, comprehension scores and preferencesBehaviour & Information Technology, 2005
- The diagnosis of pulmonary nodules: comparison between standard and inverse digitized images and conventional chest radiographsAmerican Journal of Roentgenology, 1989