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European Radiology
Published in: European Radiology 8/2020

01-08-2020 | Stroke | Neuro

Detection of emergent large vessel occlusion stroke with CT angiography is high across all levels of radiology training and grayscale viewing methods

Authors: Chelsea A. Boyd, Mahesh V. Jayaraman, Grayson L. Baird, William S. Einhorn, Matthew T. Stib, Michael K. Atalay, Jerrold L. Boxerman, Ana P. Lourenco, Gaurav Jindal, Douglas T. Hidlay, Eleanor L. DiBiasio, Ryan A. McTaggart

Published in: European Radiology | Issue 8/2020

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Abstract

Objectives

CT angiography (CTA) is essential in acute stroke to detect emergent large vessel occlusions (ELVO) and must be interpreted by radiologists with and without subspecialized training. Additionally, grayscale inversion has been suggested to improve diagnostic accuracy in other radiology applications. This study examines diagnostic performance in ELVO detection between neuroradiologists, non-neuroradiologists, and radiology residents using standard and grayscale inversion viewing methods.

Methods

A random, counterbalanced experimental design was used, where 18 radiologists with varying experiences interpreted the same patient images with and without grayscale inversion. Confirmed positive and negative ELVO cases were randomly ordered using a balanced design. Sensitivity, specificity, positive and negative predictive values as well as confidence, subjective assessment of image quality, time to ELVO detection, and overall interpretation time were examined between grayscale inversion (on/off) by experience level using generalized mixed modeling assuming a binary, negative binomial, and binomial distributions, respectively.

Results

All groups of radiologists had high sensitivity and specificity for ELVO detection (all > .94). Neuroradiologists were faster than non-neuroradiologists and residents in interpretation time, with a mean of 47 s to detect ELVO, as compared with 59 and 74 s, respectively. Residents were subjectively less confident than attending physicians. With respect to grayscale inversion, no differences were observed between groups with grayscale inversion vs. standard viewing for diagnostic performance (p = 0.30), detection time (p = .45), overall interpretation time (p = .97), and confidence (p = .20).

Conclusions

Diagnostic performance in ELVO detection with CTA was high across all levels of radiologist training level. Grayscale inversion offered no significant detection advantage.

Key Points

• Stroke is an acute vascular syndrome that requires acute vascular imaging.
• Proximal large vessel occlusions can be identified quickly and accurately by radiologists across all training levels.
• Grayscale inversion demonstrated minimal detectable benefit in the detection of proximal large vessel occlusions.
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Metadata
Title
Detection of emergent large vessel occlusion stroke with CT angiography is high across all levels of radiology training and grayscale viewing methods
Authors
Chelsea A. Boyd
Mahesh V. Jayaraman
Grayson L. Baird
William S. Einhorn
Matthew T. Stib
Michael K. Atalay
Jerrold L. Boxerman
Ana P. Lourenco
Gaurav Jindal
Douglas T. Hidlay
Eleanor L. DiBiasio
Ryan A. McTaggart
Publication date
01-08-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-06814-9

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