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Reliability and accuracy of 3-mm and 2-mm maximum intensity projection CT angiography to detect intracranial large vessel occlusion in patients with acute anterior cerebral circulation stroke

  • Diagnostic Neuroradiology
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Abstract

Purpose

To evaluate the reliability and accuracy of thick maximum intensity projection (MIP) CTA images to detect large-vessel occlusion (LVO) in the anterior circulation in patients with acute stroke.

Methods

A total of 140 acute stroke patients (41 with and 99 without LVO) were evaluated by two neuroradiologists for LVO using axial 3-mm and 2-mm MIPs.

Results

Interobserver agreement was substantial using 3-mm MIPs (ĸ = 0.67) and almost perfect using 2-mm MIPs (ĸ = 0.82). Using 3-mm MIPs, sensitivities were 80.5% and 68.3%, with specificities of 98.0% and 96.0%. Using 2-mm MIPs, sensitivities were 82.9% and 73.2%, with specificities of 98.0% and 99.0%. Sensitivity and specificity of 3 mm and 2 mm MIPs were not statistically significantly different (P ≥ 0.375). The majority of LVOs in the distal intracranial carotid artery, and/or M1-segment were correctly identified: 96.0% (observer 1, 3-mm MIPs), 88.0% (observer 2, 3-mm MIPs), 96.0% (observer 1, 2-mm MIPs), and 96.0% (observer 2, 2 mm MIPs). Using 3-mm MIP images, observers 1 and 2 missed 7/15 (46.7%) and 9/15 (60.0%) of isolated M2-segment occlusions, respectively. Using 2-mm MIP images, observers 1 and 2 missed 5/15 (33.3%) and 6/15 (40.0%) of isolated M2-segment occlusions, respectively.

Conclusion

Thick (2–3 mm) axial MIPs are not useful to detect proximal LVO in the anterior circulation.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, The Netherlands

    Bram A. C. M. Fasen, Rob A. P. Borghans, Roeland J. J. Heijboer, Frans-Jan H. Hulsmans & Robert M. Kwee

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  1. Bram A. C. M. Fasen
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  2. Rob A. P. Borghans
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  3. Roeland J. J. Heijboer
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  4. Frans-Jan H. Hulsmans
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  5. Robert M. Kwee
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Correspondence to Robert M. Kwee.

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The authors declare that they have no conflict of interest.

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All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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This retrospective study was approved by the institutional review board of our hospital and patients’ consents were waived.

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Fasen, B.A.C.M., Borghans, R.A.P., Heijboer, R.J.J. et al. Reliability and accuracy of 3-mm and 2-mm maximum intensity projection CT angiography to detect intracranial large vessel occlusion in patients with acute anterior cerebral circulation stroke. Neuroradiology 63, 1611–1616 (2021). https://doi.org/10.1007/s00234-021-02659-1

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  • DOI: https://doi.org/10.1007/s00234-021-02659-1

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