Detection of early CT signs of >1/3 middle cerebral artery infarctions -: Interrater reliability and sensitivity of CT interpretation by physicians involved in acute stroke care
Detection of early CT signs of >1/3 middle cerebral artery infarctions -: Interrater reliability and sensitivity of CT interpretation by physicians involved in acute stroke care
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DOI：
10.1161/01.str.31.7.1667
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发表时间：
2000-07-01
期刊：
影响因子：
8.3
通讯作者：
Starkman, S
中科院分区：
文献类型：
--
作者：
Kalafut, MA;Schriger, DL;Starkman, S
背景与目的：本研究有两个目的：(1)评估学术神经放射科医师通过CT扫描将急性梗死分类为>1/3大脑中动脉（MCA）受损伤，1/3 MCA急性梗死的可信度。组织纤溶酶原激活剂的研究表明，早期症状的严重梗塞和预后不良之间的关联。美国神经病学学会和美国心脏协会建议，如果出现严重梗塞的早期症状，应避免溶栓。方法：我们向3位学术神经放射学家提交了25张扫描图（正常人、急性梗死和老年梗死）。使用基于阿替普酶溶栓用于缺血性卒中急性非介入治疗(ATLANTIS)/CT顶峰标准的计分表来确定>1/3 MCA区域累及情况。25次扫描中的9次被再次呈现，以评估术后的可靠性。我们重新计算了之前的研究结果，在之前的研究中，医生解释了梗塞扫描，现在将扫描指定为>1/3 MCA， 1/3 MCA区域。急诊医生、神经科医生和普通放射科医生在bbbb113mca扫描中检测梗死存在的总体敏感性为78%。结论：神经放射科医生在检测>1/3 MCA梗死方面可以达到中等程度的一致，急诊医生、神经科医生和普通放射科医生在检测>1/3 MCA急性梗死方面相当熟练，然而，他们的表现并不能可靠地识别出所有有早期CT梗死迹象的患者，这些迹象使他们在溶栓治疗后脑出血的风险增加。
Background and Purpose-This study had 2 goals: (1) to assess interrater reliability of academic neuroradiologists when classifying acute infarction by CT scan as >1/3 middle cerebral artery (MCA) involvement, 1/3 MCA acute infarctions. Studies of tissue plasminogen activator show an association between early signs of major infarction and poor outcome. The American Academy of Neurology and the American Heart Association recommend avoiding thrombolysis if early signs of major infarction are present.Methods-We presented 25 scans (normals, acute infarctions, and old infarctions) to 3 academic neuroradiologists. A scoring sheet based on Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS)/CT Summit criteria was used to determine >1/3 MCA territory involvement. Nine of the 25 scans were presented again to assess intrarater reliability. We recalculated results of our previous study in which physicians interpreted infarction scans, now designating the scans as >1/3 MCA, 1/3 MCA territory. Overall sensitivity for emergency physicians, neurologists, and general radiologists for detecting the presence of infarction in scans rated as >113 MCA was 78%.Conclusions-Neuroradiologists can achieve moderate agreement in detecting >1/3 MCA infarction, The emergency physicians, neurologists, and general radiologists tested were reasonably skilled at detecting >1/3 MCA acute infarction, However, their performance did not reliably identify all patients who have early CT infarct signs that place them at increased risk for cerebral hemorrhage after thrombolytic therapy.