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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 21:643-646 (4 2000)
© 2000 American Society of Neuroradiology

ARTICLE

A Standardized Method for Measuring Intracranial Arterial Stenosis

Owen B. Samuels^,a, Gregg J. Joseph^a, Michael J. Lynn^a, Harriet A. Smith^a and Marc I. Chimowitz^a

^a From the Departments of Neurology (O.B.S., H.A.S., M.I.C.), Neurosurgery (O.B.S.), Radiology (G.J.J.), and Biostatistics (M.J.L.), Emory University, Atlanta GA.

BACKGROUND AND PURPOSE: Atherosclerosis of the major intracranial arteries is an important cause of ischemic stroke. We established measurement criteria to assess percent stenosis of a major intracranial artery (carotid, middle cerebral, vertebral, basilar) and determined the interobserver/intraobserver agreements and interclass/intraclass correlations of these measurements.

METHODS: We defined percent stenosis of an intracranial artery as follows: percent stenosis = [(1 - (D_stenosis/D_normal))] x 100, where D_stenosis = the diameter of the artery at the site of the most severe stenosis and D_normal = the diameter of the proximal normal artery. If the proximal segment was diseased, contingency sites were chosen to measure D_normal: distal artery (second choice), feeding artery (third choice). Using a hand-held digital caliper, three neuroradiologists independently measured D_stenosis and D_normal of 24 stenotic intracranial arteries. Each observer repeated the readings 4 weeks later. We determined how frequently two observers' measurements of percent stenosis of each of the 24 diseased arteries differed by 10% or less.

RESULTS: Among the three pairs of observers, interobserver agreements were 88% (observer 1 versus observer 2), 79% (observer 1 versus observer 3), 75% (observer 2 versus observer 3) for the first reading and were 75% (observer 1 versus observer 2), 100% (observer 1 versus observer 3), and 71% (observer 2 versus observer 3) for the second reading. Intraobserver agreement for each of the observers was 88%, 83%, and 100%. Interclass correlation was 85% (first reading) and 87% (second reading). Intraclass correlation was 92% (first and second readings combined).

CONCLUSION: This method shows good interobserver and intraobserver agreements for the measurement of intracranial stenosis of a major artery. If validated in subsequent studies, this method may serve as a standard for the measurement of percent stenosis of an intracranial artery.

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