Development and validation of visual grading system for stenosis in intracranial atherosclerotic disease on time-of-flight magnetic resonance angiography
Objectives Although the overestimation problem of time-of-flight magnetic resonance angiography (TOF-MRA) applying the warfarin-aspirin symptomatic intracranial disease (WASID) method to assess intracranial arterial stenosis has often been suggested, no pertinent grading system for TOF-MRA has been...
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Veröffentlicht in: | European radiology 2022-04, Vol.32 (4), p.2781-2790 |
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Sprache: | eng |
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Zusammenfassung: | Objectives
Although the overestimation problem of time-of-flight magnetic resonance angiography (TOF-MRA) applying the warfarin-aspirin symptomatic intracranial disease (WASID) method to assess intracranial arterial stenosis has often been suggested, no pertinent grading system for TOF-MRA has been developed. We aimed to develop and evaluate the performance of a visual grading system for intracranial arterial stenosis on TOF-MRA (MRA
VICAST
).
Methods
This single-center cohort study analyzed prospective observational registry data from a comprehensive stroke center between January 2014 and February 2020. Patients with confirmed stenosis of the intracranial large arteries who underwent confirmative digital subtraction angiography (DSA) were included; a 4-point grading system was developed based on physical characteristics of TOF-MRA. The overall diagnostic accuracies of MRA
VICAST
for each grade, interobserver reproducibility, and positive predictive values for > 50% and > 70% stenoses were evaluated.
Results
We analyzed 132 segments with intracranial atherosclerotic stenosis from 71 patients (34 men and 37 women; mean age, 61.0 ± 15.25 years; range, 21–89 years). The overall diagnostic accuracy of MRA
VICAST
(93.9%, 124/132) was higher than that of MRA
WASID
(50.8%, 67/132) for each grade. The degree of stenosis did not differ significantly between MRA
VICAST
and DSA
WASID
(
p
= .849). Regarding reproducibility, MRA
VICAST
demonstrated excellent interobserver agreement (ICC, 0.989; 95% CI, 0.979–0.999). The positive predictive values of MRA
VICAST
for the diagnosis of > 50% and > 70% stenoses were 97.3% and 100.0%, respectively.
Conclusions
The new intuitive grading system accurately and reliably determined the degree of stenosis in intracranial arterial atherosclerosis patients. MRA
VICAST
could be a versatile alternative to MRA
WASID
for evaluating intracranial arterial stenosis.
Key Points
•
In this retrospective diagnostic study (sample: 132 stenotic segments), the overall accuracy of the visual grading system (MRA
VICAST
) was 94%, and positive predictive value for
>
50% stenosis was 97%.
•
In the era of medical treatment for intracranial atherosclerotic stenosis, MRA
VICAST
could be a versatile alternative method to MRA
WASID
for evaluating intracranial arterial stenosis. |
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ISSN: | 0938-7994 1432-1084 |
DOI: | 10.1007/s00330-021-08319-5 |