Development and validation of visual grading system for stenosis in intracranial atherosclerotic disease on time-of-flight magnetic resonance angiography
- Authors
- You, Sung-Hye; Kim, Byungjun; Yang, Kyung-Sook; Kim, Bo Kyu; Woo, Seungtae; Park, Sang Eun
- Issue Date
- 4월-2022
- Publisher
- SPRINGER
- Keywords
- Angiography, digital subtraction; Intracranial arteriosclerosis; Magnetic resonance angiography; Stroke
- Citation
- EUROPEAN RADIOLOGY, v.32, no.4, pp.2781 - 2790
- Indexed
- SCIE
SCOPUS
- Journal Title
- EUROPEAN RADIOLOGY
- Volume
- 32
- Number
- 4
- Start Page
- 2781
- End Page
- 2790
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/143246
- DOI
- 10.1007/s00330-021-08319-5
- ISSN
- 0938-7994
- Abstract
- 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.
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