Publication Date:
2014-08-26
Description:
Background and Purpose— Diffusion-weighted image fluid-attenuated inversion recovery (FLAIR) mismatch has been considered to represent ischemic lesion age. However, the inter-rater agreement of diffusion-weighted image FLAIR mismatch is low. We hypothesized that color-coded images would increase its inter-rater agreement. Methods— Patients with ischemic stroke 〈24 hours of a clear onset were retrospectively studied. FLAIR signal change was rated as negative, subtle, or obvious on conventional and color-coded FLAIR images based on visual inspection. Inter-rater agreement was evaluated using and percent agreement. The predictive value of diffusion-weighted image FLAIR mismatch for identification of patients 〈4.5 hours of symptom onset was evaluated. Results— One hundred and thirteen patients were enrolled. The inter-rater agreement of FLAIR signal change improved from 69.9% ( k =0.538) with conventional images to 85.8% ( k =0.754) with color-coded images ( P =0.004). Discrepantly rated patients on conventional, but not on color-coded images, had a higher prevalence of cardioembolic stroke ( P =0.02) and cortical infarction ( P =0.04). The positive predictive value for patients 〈4.5 hours of onset was 85.3% and 71.9% with conventional and 95.7% and 82.1% with color-coded images, by each rater. Conclusions— Color-coded FLAIR images increased the inter-rater agreement of diffusion-weighted image FLAIR recovery mismatch and may ultimately help identify unknown-onset stroke patients appropriate for thrombolysis.
Keywords:
Acute Cerebral Infarction, Computerized tomography and Magnetic Resonance Imaging
Print ISSN:
0039-2499
Electronic ISSN:
1524-4628
Topics:
Medicine
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