PT  - JOURNAL ARTICLE
AU  - W. Boisseau
AU  - A. Benaissa
AU  - R. Fahed
AU  - J.-L. Amegnizin
AU  - S. Smajda
AU  - S. Benadjaoud
AU  - A.M. Benadjaoud
AU  - L. Saint-Val
AU  - Q. Alias
AU  - P. Iorio
AU  - S. Yang
AU  - K. Zuber
AU  - E. Kalsoum
AU  - J. Hodel
TI  - 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
AID  - 10.3174/ajnr.A7054
DP  - 2021 Jun 01
TA  - American Journal of Neuroradiology
PG  - 1116--1122
VI  - 42
IP  - 6
4099  - http://www.ajnr.org/content/42/6/1116.short
4100  - http://www.ajnr.org/content/42/6/1116.full
SO  - Am. J. Neuroradiol.2021 Jun 01; 42
AB  - 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.AISacute ischemic strokeCEcontrast-enhancedPOpseudo-occlusion