Aim: To test the performance of computed tomography angiography "source images" (CTA-SI) versus unenhanced CT (NCCT) for stroke detection and extent using the Alberta Stroke Programme Early CT Score (ASPECTS), and examine the effect of experience and clinical history. Materials and methods: Studies of 23 consecutive patients presenting within 4.5 h were analysed by three reviewers of varying experience. Each reviewer, blinded to clinical information reviewed a random order of NCCT and CTA-SI and documented side of infarct and the ASPECTS. The readings were repeated for CTA-SI with and without clinical information. Performance measures and observer agreement were calculated. Applying an ASPECTS threshold of ≤ 7, the number of patients misclassified was determined. Results: CTA-SI improved trainee accuracy by 9%, but had little impact on more experienced readers. The accuracy and sensitivity of stroke extent assessment was increased for all readers, but was greatest for the trainee (17% and 12%, respectively). Clinical history contributed little to CTA-SI accuracy. Observer agreement was higher for CTA-SI. NCCT could have resulted in the misclassification of more patients than CTA-SI. Conclusion: CTA-SI are an important adjunct in acute stroke assessment, improving stroke extent determination for all readers irrespective of level of experience. In addition less experienced readers may benefit from CTA-SI for detection of presence of strokes. CTA-SI performance appears independent of clinical history. CTA-SI resulted in fewer misclassified patients if an ASPECTS threshold of ≤ 7 is considered.
|Number of pages||6|
|State||Published - 1 May 2007|
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging