Abstract
Background: Hemorrhagic transformation after acute ischemic stroke is a dreaded and severe complication of thrombolysis and thrombectomy. However, its detection on post-thrombectomy conventional non-contrast computed tomography (CT) scan can be complicated by the frequent (and sometimes concomitant) presence of contrast, resulting in changes in management.Aims: Our objective was to assess the inter- and intra-rater reliability for the detection of blood and/or contrast on day-1 post-thrombectomy CT scans.Methods: A total of 18 raters across 3 different specialties independently examined 30 post-thrombectomy CT scans selected from the Aspiration vs. STEnt-Retriever (ASTER) trial. They were asked to judge the presence of blood and contrast. Thirty days later, the same 18 raters again independently judged the 30 scans, in randomized order. Agreement was measured with Fleiss' and Cohen's K statistics.Results: Overall agreement on blood and/ or contrast presence was only fair, k = 0.291 (95% CI = 0.273–0.309). There were 0 scans with consensus among the 18 readers on the presence of blood and/or contrast. However, intra-rater global agreement across all 18 physicians was relatively high, with a median kappa value of 0.675. This intra-rater consistency was seen across all specialties, regardless of level of training.Conclusion: Physician judgment for the presence of blood and/or contrast on day-1 post-thrombectomy non-contrast CT scan shows limited inter-observer reliability. Advanced imaging modalities may then be warranted for challenging clinical cases.
Highlights
Endovascular thrombectomy (EVT) has become the standard of care for patients with acute ischemic stroke (AIS) secondary to large vessel occlusions [1]
We aimed to evaluate inter-rater and intra-rater reliability for detection of hemorrhagic transformation (HT) and contrast staining (CS) on noncontrast computed tomography (CT) (NCCT) in EVT patients
The inter-rater agreement for the detection of CS was only fair, k = 0.269 (Figure 1)
Summary
Endovascular thrombectomy (EVT) has become the standard of care for patients with acute ischemic stroke (AIS) secondary to large vessel occlusions [1]. One of the major complications after AIS is hemorrhagic transformation (HT), reported to be up to 35% after EVT [2]. Arterial injection of iodine contrast during EVT may mimic the appearance of HT, due to its hyper-dense appearance on follow-up conventional noncontrast CT (NCCT) [3]. We aimed to evaluate inter-rater and intra-rater reliability for detection of HT and contrast staining (CS) on NCCT in EVT patients. Hemorrhagic transformation after acute ischemic stroke is a dreaded and severe complication of thrombolysis and thrombectomy. Its detection on post-thrombectomy conventional non-contrast computed tomography (CT) scan can be complicated by the frequent (and sometimes concomitant) presence of contrast, resulting in changes in management
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