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Figures
- FIG 1.
A 75-year-old male patient with acute ischemic stroke. At initial CTA evaluation, occlusion of 1 of the M2 segment branches of the left middle cerebral artery (arrows on all slices) was missed. Consecutive axial CTA slices in a caudocranial direction (A–D) show a contrast filling defect in a branch of the left M2 segment (arrows in C and D). Note that 2 adjacent branches of the left M2 segment show normal contrast filling on all slices (arrowheads).
- FIG 2.
A 70-year-old male patient with acute ischemic stroke. At initial CTA evaluation, LVO due to a calcified embolus in the M2 segment of the left middle cerebral artery (arrows in CTA image, A; and in a noncontrast head CT image, B) was misinterpreted as clinically irrelevant calcification. Follow-up MR imaging (FLAIR image, C; and diffusion-weighted image, D) 1 day after CTA reveals infarction in the left middle cerebral artery territory (arrows).
Tables
Location of LVO No. (%) No. of Missed LVOs at Initial CTA Evaluation (%) Distal intracranial carotid artery 1 (1.2%) 0 (0%) Distal intracranial carotid artery and M1 segment 10 (11.9%) 0 (0%) Distal intracranial carotid artery and M2 segment 1 (1.2%) 0 (0%) M1 segment 31 (36.9%) 3 (17.6%) M2 segment 40 (47.6%) 14 (82.4%) A1 segment 1 (1.2%) 0 (0%) A2 segment 0 0 (0%) - Table 2:
Variables potentially associated with missing LVO at initial CTA evaluation; results of univariate logistic regression analysisa
Variables Odds Ratio (95% CI) P Value Interpreter Non-neuroradiologists (n = 33) vs neuroradiologists (n = 27) 7.14 (1.43–35.57) .02 Senior residents (n = 24) vs neuroradiologists (n = 27) 1.79 (0.27–11.71) .55 Senior residents (n = 24) vs non-neuroradiologists (n = 33) 0.25 (0.06–1.02) .05 Time of CTA interpretation, on-call hours (n = 40) vs office hours (n = 44) 1.89 (0.63–5.70) .26 Reporting of lateralizing symptoms/signs or suspected location of stroke on the request form for CTA; yes (n = 58) vs no (n = 26) 0.91 (0.29–2.92) .88 Location of LVO; M2 segment (n = 40) vs distal internal carotid artery and/or M1 segment (n = 42) 6.77 (1.79–25.57) .005 ↵a Nos. in parentheses in column 1 represent the number of CTA scans.
- Table 3:
Variables potentially associated with missing LVO at initial CTA evaluation; results of multivariate logistic regression analysisa
Variables Odds Ratio (95% CI) P Value Interpreter Non-neuroradiologists (n = 33) vs neuroradiologists (n = 27) 5.62 (1.06–29.85) .04 Senior residents (n = 24) vs neuroradiologists (n = 27) 1.63 (0.23–11.37) .62 Senior residents (n = 24) vs non-neuroradiologists (n = 33) 0.29 (0.07–1.26) .10 Location of LVO; M2 segment (n = 40) vs distal internal carotid artery and/or M1 segment (n = 42) 5.69 (1.44–22.57) .01 ↵a Nos. in parentheses in column 1 represent the number of CTA scans.
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