CT Angiography in Evaluating Large-Vessel Occlusion in Acute Anterior Circulation Ischemic Stroke: Factors Associated with Diagnostic Error in Clinical Practice.

Autor:	Fasen BACM; From the Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands., Heijboer RJJ; From the Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands., Hulsmans FH; From the Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands., Kwee RM; From the Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/Geleen, the Netherlands. rmkwee@gmail.com.
Jazyk:	angličtina
Zdroj:	AJNR. American journal of neuroradiology [AJNR Am J Neuroradiol] 2020 Apr; Vol. 41 (4), pp. 607-611. Date of Electronic Publication: 2020 Mar 12.
DOI:	10.3174/ajnr.A6469
Abstrakt:	Background and Purpose: It is currently not completely clear how well radiologists perform in evaluating large-vessel occlusion on CTA in acute ischemic stroke. The purpose of this study was to investigate potential factors associated with diagnostic error. Materials and Methods: Five hundred twenty consecutive patients with a clinical diagnosis of acute ischemic stroke (49.4% men; mean age, 72 years) who underwent CTA to evaluate large-vessel occlusion of the proximal anterior circulation were included. CTA scans were retrospectively reviewed by a consensus panel of 2 neuroradiologists. Logistic regression analysis was performed to investigate the association between several variables and missed large-vessel occlusion at the initial CTA interpretation. Results: The prevalence of large-vessel occlusion was 16% (84/520 patients); 20% (17/84) of large-vessel occlusions were missed at the initial CTA evaluation. In multivariate analysis, non-neuroradiologists were more likely to miss large-vessel occlusion compared with neuroradiologists (OR = 5.62; 95% CI, 1.06-29.85; P = .04), and occlusions of the M2 segment were more likely to be missed compared with occlusions of the distal internal carotid artery and/or M1 segment (OR = 5.69; 95% CI, 1.44-22.57; P = .01). There were no calcified emboli in initially correctly identified large-vessel occlusions. However, calcified emboli were present in 4 of 17 (24%) initially missed or misinterpreted large-vessel occlusions. Conclusions: Several factors may have an association with missing a large-vessel occlusion on CTA, including the CTA interpreter (non-neuroradiologists versus neuroradiologists), large-vessel occlusion location (M2 segment versus the distal internal carotid artery and/or M1 segment), and large-vessel occlusion caused by calcified emboli. Awareness of these factors may improve the accuracy in interpreting CTA and eventually improve stroke outcome. (© 2020 by American Journal of Neuroradiology.)
Databáze:	MEDLINE
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