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Bing F, Berger I, Fabry A, Moroni AL, Casile C, Morel N, M'Biene S, Guellerin J, Pignal-Jacquard C, Vadot W, Rodier G, Delory T, Jund J. Intra- and inter-rater consistency of dual assessment by radiologist and neurologist for evaluating DWI-ASPECTS in ischemic stroke. Rev Neurol (Paris) 2021; 178:219-225. [PMID: 34785042 DOI: 10.1016/j.neurol.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To estimate the intra -and inter-rater consistency of radiologist and neurologist working in pairs attributing DWI-ASPECTS (Diffusion Alberta Stroke Program Early CT Score) in patients with acute middle cerebral artery ischemic stroke referred for mechanical thrombectomy, intravenous thrombolysis or bridging therapy. METHODS Five neurologists and 5 radiologists working in pairs and in hour period scored independently and in two reading sessions anonymized DWI-ASPECTS of 80 patients presenting with acute anterior ischaemic stroke in our center. We measured agreement between pairs using intraclass correlation coefficients (ICCs). A Fleiss kappa was used for dichotomized (0-6;7-10) and trichotomized (0-3;4-6;7-10) ASPECTS. The interrater distribution of the score in the trichotomized (0-3;4-6;7-10) ASPECTS was calculated. We determined the interrater (Cohen kappa) and intrarater (Fleiss kappa) agreement on the ASPECTS regions. RESULTS The average DWI-ASPECTS was 6.35 (SD±2.44) for the first reading, and 6.47 (SD±2.44) for the second one. The ICC was 0.853 (95%CI, 0.798-0.896) for the interrater, and 0.862 (95%CI, 0.834-0.885) for the intrarater evaluation. Kappa coefficients were high for dichotomized (k=0.75) and trichotomized (k=0.64) ASPECTS. Evaluators agreement on the ASPECTS category (0-3), (4-6) and (7-10) was 88, 76 and 93% respectively. The anatomic region infarcted was well identified (k=0.70-0.77), except for the internal capsula (k=0.57). Interrater agreement was fair for M5 (k=0.37), moderate for internal capsula (0.52) and substantial for the other regions (0.60-0.79). CONCLUSIONS Reliability of DWI-ASPECTS is good when determined by radiologist and neurologist working in pairs, which corresponds to our current clinical practice. However, discrepancies are possible for cut-off determination, which may impact the indication of thrombectomy, and for the determination of the exact infarcted region. Agreement to propose category (4-6) is lower than for (0-3) and (8-10) ASPECTS categories.
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Affiliation(s)
- F Bing
- Radiology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France.
| | - I Berger
- Neurology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - A Fabry
- Radiology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - A-L Moroni
- Radiology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - C Casile
- Radiology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - N Morel
- Neurology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - S M'Biene
- Radiology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - J Guellerin
- Neurology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - C Pignal-Jacquard
- Radiology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - W Vadot
- Neurology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - G Rodier
- Neurology Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - T Delory
- Clinical Research Unit, CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
| | - J Jund
- Medical Information and Evaluation Unit (SIEM), CHANGE, 1, avenue de l'Hôpital, 74370 Metz-Tessy, France
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Bing F, Berger I, Rodier G, Casile C, Morel N, M’Biene S, Vadot W, Moroni AL, Guellerin J, Pignal-Jacquard C. Étude par binômes radiologue/neurologue des corrélations inter- et intra-observateurs du DWI-ASPECTS en phase aiguë de l’infarctus cérébral. J Neuroradiol 2018. [DOI: 10.1016/j.neurad.2018.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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