Monday, March 25, 2024

Clinical uncertainty in large vessel occlusion ischemic stroke: does automated perfusion imaging make a difference? An intra-rater and inter-rater agreement study

Since you're not even measuring 100% recovery you're not doing research correctly. 100% recovery is the only goal in stroke! 

“What's measured, improves.” So said management legend and author Peter F. Drucker 

 Clinical uncertainty in large vessel occlusion ischemic stroke: does automated perfusion imaging make a difference? An intra-rater and inter-rater agreement study
  1. Jose Danilo Bengzon Diestro1,2,3,4,
  2. Robert Fahed5,
  3. Abdelsimar Tan Omar6,
  4. Christine Hawkes7,
  5. Eef J Hendriks8,
  6. Clare Enriquez7,
  7. Muneer Eesa9,
  8. Grant Stotts5,
  9. Hubert Lee10,
  10. Shashank Nagendra11,
  11. Alexandre Poppe12,
  12. Célina Ducroux5,
  13. Timothy Lim13,
  14. Karl Narvacan14,
  15. Michael Rizzuto15,
  16. Afra Alfalahi4,
  17. Hidehisa Nishi4,16,
  18. Pragyan Sarma4,
  19. Ze'ev Itsekson Hayosh4,8,
  20. Katrina Ignacio11,
  21. William Boisseau17,
  22. Eduardo Pimenta Ribeiro Pontes Almeida18,
  23. Anass Benomar19,
  24. Mohammed A Almekhlafi20,
  25. Genvieve Milot21,
  26. Aviraj Deshmukh22,
  27. Kislay Kishore6,
  28. Donatella Tampieri23,
  29. Jeffrey Wang2,
  30. Abhilekh Srivastava24,
  31. Daniel Roy25,
  32. Federico Carpani26,
  33. Nima Kashani27,
  34. Claudia Candale-Radu28,
  35. Nishita Singh28,
  36. Maria Bres Bullrich29,
  37. Robert Sarmiento30,
  38. Ryan T Muir11,
  39. Carmen Parra-Fariñas31,
  40. Stephanie Reiter7,
  41. Yan Deschaintre12,
  42. Ravinder-Jeet Singh22,
  43. Vivek Bodani8,
  44. Aristeidis Katsanos24,
  45. Ronit Agid8,
  46. Atif Zafar2,
  47. Vitor M Pereira3,4,32,
  48. Julian Spears32,
  49. Thomas R Marotta3,4,
  50. Pascal Djiadeu1,33,
  51. Sunjay Sharma1,6,
  52. Forough Farrokhyar1,33,34
  1. Correspondence to Dr Jose Danilo Bengzon Diestro, Department of Medicine, University of Toronto, Toronto M5B 1W8, Ontario, Canada; danni.diestro@gmail.com

Abstract

Background Limited research exists regarding the impact of neuroimaging on endovascular thrombectomy (EVT) decisions for late-window cases of large vessel occlusion (LVO) stroke.

Objective T0 assess whether perfusion CT imaging: (1) alters the proportion of recommendations for EVT, and (2) enhances the reliability of EVT decision-making compared with non-contrast CT and CT angiography.

Methods We conducted a survey using 30 patients drawn from an institutional database of 3144 acute stroke cases. These were presented to 29 Canadian physicians with and without perfusion imaging. We used non-overlapping 95% confidence intervals and difference in agreement classification as criteria to suggest a difference between the Gwet AC1 statistics (κG).

Results The percentage of EVT recommendations differed by 1.1% with or without perfusion imaging. Individual decisions changed in 21.4% of cases (11.3% against EVT and 10.1% in favor). Inter-rater agreement (κG) among the 29 raters was similar between non-perfusion and perfusion CT neuroimaging (κG=0.487; 95% CI 0.327 to 0.647 and κG=0.552; 95% CI 0.430 to 0.675). The 95% CIs overlapped with moderate agreement in both. Intra-rater agreement exhibited overlapping 95% CIs for all 28 raters. κG was either substantial or excellent (0.81–1) for 71.4% (20/28) of raters in both groups.

Conclusions Despite the minimal difference in overall EVT recommendations with either neuroimaging protocol one in five decisions changed with perfusion imaging. Regarding agreement we found that the use of automated CT perfusion images does not significantly impact the reliability of EVT decisions for patients with late-window LVO.

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2023-021429

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