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Research ArticleExtracranial Vascular

Delayed Contrast-Enhanced MR Angiography for the Assessment of Internal Carotid Bulb Patency in the Context of Acute Ischemic Stroke: An Accuracy, Interrater, and Intrarater Agreement Study

W. Boisseau, A. Benaissa, R. Fahed, J.-L. Amegnizin, S. Smajda, S. Benadjaoud, A.M. Benadjaoud, L. Saint-Val, Q. Alias, P. Iorio, S. Yang, K. Zuber, E. Kalsoum and J. Hodel
American Journal of Neuroradiology June 2021, 42 (6) 1116-1122; DOI: https://doi.org/10.3174/ajnr.A7054
W. Boisseau
aFrom the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
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A. Benaissa
aFrom the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
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R. Fahed
bDepartment of Interventional Neuroradiology (R.F., S.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
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J.-L. Amegnizin
aFrom the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
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S. Smajda
bDepartment of Interventional Neuroradiology (R.F., S.S.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
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S. Benadjaoud
aFrom the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
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A.M. Benadjaoud
dDepartment of Radiobiology and Epidemiology (A.M.B.), Institute for Radiological Protection and Nuclear Safety, Fontenay-Aux-Roses, France
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L. Saint-Val
aFrom the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
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Q. Alias
aFrom the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
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P. Iorio
aFrom the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
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S. Yang
aFrom the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
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K. Zuber
eClinical Research Unit (K.Z.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
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E. Kalsoum
aFrom the Department of Neuroradiology (W.B., A.B., J.-L.A., S.B., L.S.-V., Q.A., P.I., S.Y., E.K.), Centre-Hospitalier-Universitaire Henri Mondor, Créteil, France
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J. Hodel
cDepartment of Radiology, (J.H.), Groupe-Hospitalier-Paris-Saint-Joseph, Paris, France
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Abstract

BACKGROUND AND PURPOSE: CTA has shown limited accuracy and reliability in distinguishing tandem occlusions and pseudo-occlusions on initial acute stroke imaging. The utility of early and delayed contrast-enhanced MRA in this setting is unknown. We aimed to assess the accuracy and reliability of early and delayed contrast-enhanced MRA for carotid bulb patency in patients with acute ischemic stroke.

MATERIALS AND METHODS: We retrospectively reviewed patients who had ICA occlusion and underwent thrombectomy with preprocedural early and delayed contrast-enhanced MRA in a single comprehensive stroke center. During 2 sessions, 10 raters independently assessed 32 cases with early contrast-enhanced MRA (with an additional delayed contrast-enhanced MRA sequence during the second reading session). Their judgments were compared with DSA as a reference standard. Accuracy and interrater agreement were measured. Five raters undertook a third reading session to assess intrarater agreement.

RESULTS: Accuracy for the assessment of carotid bulb patency with early contrast-enhanced MRA was limited (69%; 95% CI, 59%–79%), with moderate interrater agreement (κ = 0.42; 95% CI, 0.27–0.55). The second reading with an additional delayed contrast-enhanced MRA sequence improved both accuracy (82%; 95% CI, 73%–91%; P < .001) (raters corrected 43%–77% of incorrect diagnoses with early contrast-enhanced MRA alone; mean = 59%) and interrater agreement (κ = 0.56; 95% CI, 0.41–0.73; P = .07). Intrarater agreement was almost perfect, substantial, and moderate for 3, 1, and 1 raters.

CONCLUSIONS: Early contrast-enhanced MRA has limited accuracy and repeatability for the evaluation of carotid bulb patency in acute ischemic stroke. The additional delayed contrast-enhanced MRA sequence may improve accuracy and reliability.

ABBREVIATIONS:

AIS
acute ischemic stroke
CE
contrast-enhanced
PO
pseudo-occlusion
  • © 2021 by American Journal of Neuroradiology
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American Journal of Neuroradiology: 42 (6)
American Journal of Neuroradiology
Vol. 42, Issue 6
1 Jun 2021
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Delayed Contrast-Enhanced MR Angiography for the Assessment of Internal Carotid Bulb Patency in the Context of Acute Ischemic Stroke: An Accuracy, Interrater, and Intrarater Agreement Study
W. Boisseau, A. Benaissa, R. Fahed, J.-L. Amegnizin, S. Smajda, S. Benadjaoud, A.M. Benadjaoud, L. Saint-Val, Q. Alias, P. Iorio, S. Yang, K. Zuber, E. Kalsoum, J. Hodel
American Journal of Neuroradiology Jun 2021, 42 (6) 1116-1122; DOI: 10.3174/ajnr.A7054

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Delayed Contrast-Enhanced MR Angiography for the Assessment of Internal Carotid Bulb Patency in the Context of Acute Ischemic Stroke: An Accuracy, Interrater, and Intrarater Agreement Study
W. Boisseau, A. Benaissa, R. Fahed, J.-L. Amegnizin, S. Smajda, S. Benadjaoud, A.M. Benadjaoud, L. Saint-Val, Q. Alias, P. Iorio, S. Yang, K. Zuber, E. Kalsoum, J. Hodel
American Journal of Neuroradiology Jun 2021, 42 (6) 1116-1122; DOI: 10.3174/ajnr.A7054
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