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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleORIGINAL RESEARCH

Carotid Plaque-RADS: Inter-and intra-reader agreement and learning curve analysis in Computed Tomography Angiography

Luca Saba, Roberta Scicolone, Gian Luca Chabert, Daniel Bos, Anna Kopczak, Mahmud Mossa-Basha, Jae W. Song, Roberto Sanfilippo, Andreas Schindler, Andrew N. Nicolaides, M. Eline Kooi, Tobias Saam, Riccardo Cau and Giuseppe Lanzino
American Journal of Neuroradiology April 2025, ajnr.A8769; DOI: https://doi.org/10.3174/ajnr.A8769
Luca Saba
From the Department of Radiology (L.S., R.S., G.L.C., R.C.), Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy; Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam (D.B.), University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC (D.B.), Rotterdam, the Netherlands; Department of Cardiovascular Sciences (D.B.), KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology (D.B.), Harvard School of Public Health, Boston, Massachusetts, USA; Institute for Stroke and Dementia Research (A.K.), University Hospital, LMU Munich, Munich, Germany; University of Washington Medical Center (M.M.B.), Seattle, Washington, USA; Department of Radiology (J.W.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Vascular Surgery(R.S), Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari—Polo di Monserrato, Cagliari, Italy; Institute of Neuroradiology (A.S.,T.S.), University Hospital, LMU Munich, Germany; Vascular Screening and Diagnostic Centre (A.N.N.), Nicosia, Cyprus; University of Nicosia Medical School (A.N.N.), Nicosia, Cyprus; Department of Vascular Surgery (A.N.N), Imperial College, London, United Kingdom; Department of Radiology and Nuclear Medicine (M.E.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota, USA
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Roberta Scicolone
From the Department of Radiology (L.S., R.S., G.L.C., R.C.), Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy; Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam (D.B.), University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC (D.B.), Rotterdam, the Netherlands; Department of Cardiovascular Sciences (D.B.), KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology (D.B.), Harvard School of Public Health, Boston, Massachusetts, USA; Institute for Stroke and Dementia Research (A.K.), University Hospital, LMU Munich, Munich, Germany; University of Washington Medical Center (M.M.B.), Seattle, Washington, USA; Department of Radiology (J.W.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Vascular Surgery(R.S), Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari—Polo di Monserrato, Cagliari, Italy; Institute of Neuroradiology (A.S.,T.S.), University Hospital, LMU Munich, Germany; Vascular Screening and Diagnostic Centre (A.N.N.), Nicosia, Cyprus; University of Nicosia Medical School (A.N.N.), Nicosia, Cyprus; Department of Vascular Surgery (A.N.N), Imperial College, London, United Kingdom; Department of Radiology and Nuclear Medicine (M.E.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota, USA
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Gian Luca Chabert
From the Department of Radiology (L.S., R.S., G.L.C., R.C.), Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy; Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam (D.B.), University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC (D.B.), Rotterdam, the Netherlands; Department of Cardiovascular Sciences (D.B.), KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology (D.B.), Harvard School of Public Health, Boston, Massachusetts, USA; Institute for Stroke and Dementia Research (A.K.), University Hospital, LMU Munich, Munich, Germany; University of Washington Medical Center (M.M.B.), Seattle, Washington, USA; Department of Radiology (J.W.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Vascular Surgery(R.S), Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari—Polo di Monserrato, Cagliari, Italy; Institute of Neuroradiology (A.S.,T.S.), University Hospital, LMU Munich, Germany; Vascular Screening and Diagnostic Centre (A.N.N.), Nicosia, Cyprus; University of Nicosia Medical School (A.N.N.), Nicosia, Cyprus; Department of Vascular Surgery (A.N.N), Imperial College, London, United Kingdom; Department of Radiology and Nuclear Medicine (M.E.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota, USA
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Daniel Bos
From the Department of Radiology (L.S., R.S., G.L.C., R.C.), Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy; Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam (D.B.), University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC (D.B.), Rotterdam, the Netherlands; Department of Cardiovascular Sciences (D.B.), KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology (D.B.), Harvard School of Public Health, Boston, Massachusetts, USA; Institute for Stroke and Dementia Research (A.K.), University Hospital, LMU Munich, Munich, Germany; University of Washington Medical Center (M.M.B.), Seattle, Washington, USA; Department of Radiology (J.W.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Vascular Surgery(R.S), Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari—Polo di Monserrato, Cagliari, Italy; Institute of Neuroradiology (A.S.,T.S.), University Hospital, LMU Munich, Germany; Vascular Screening and Diagnostic Centre (A.N.N.), Nicosia, Cyprus; University of Nicosia Medical School (A.N.N.), Nicosia, Cyprus; Department of Vascular Surgery (A.N.N), Imperial College, London, United Kingdom; Department of Radiology and Nuclear Medicine (M.E.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota, USA
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Anna Kopczak
From the Department of Radiology (L.S., R.S., G.L.C., R.C.), Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy; Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam (D.B.), University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC (D.B.), Rotterdam, the Netherlands; Department of Cardiovascular Sciences (D.B.), KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology (D.B.), Harvard School of Public Health, Boston, Massachusetts, USA; Institute for Stroke and Dementia Research (A.K.), University Hospital, LMU Munich, Munich, Germany; University of Washington Medical Center (M.M.B.), Seattle, Washington, USA; Department of Radiology (J.W.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Vascular Surgery(R.S), Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari—Polo di Monserrato, Cagliari, Italy; Institute of Neuroradiology (A.S.,T.S.), University Hospital, LMU Munich, Germany; Vascular Screening and Diagnostic Centre (A.N.N.), Nicosia, Cyprus; University of Nicosia Medical School (A.N.N.), Nicosia, Cyprus; Department of Vascular Surgery (A.N.N), Imperial College, London, United Kingdom; Department of Radiology and Nuclear Medicine (M.E.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota, USA
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Mahmud Mossa-Basha
From the Department of Radiology (L.S., R.S., G.L.C., R.C.), Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy; Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam (D.B.), University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC (D.B.), Rotterdam, the Netherlands; Department of Cardiovascular Sciences (D.B.), KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology (D.B.), Harvard School of Public Health, Boston, Massachusetts, USA; Institute for Stroke and Dementia Research (A.K.), University Hospital, LMU Munich, Munich, Germany; University of Washington Medical Center (M.M.B.), Seattle, Washington, USA; Department of Radiology (J.W.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Vascular Surgery(R.S), Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari—Polo di Monserrato, Cagliari, Italy; Institute of Neuroradiology (A.S.,T.S.), University Hospital, LMU Munich, Germany; Vascular Screening and Diagnostic Centre (A.N.N.), Nicosia, Cyprus; University of Nicosia Medical School (A.N.N.), Nicosia, Cyprus; Department of Vascular Surgery (A.N.N), Imperial College, London, United Kingdom; Department of Radiology and Nuclear Medicine (M.E.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota, USA
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Jae W. Song
From the Department of Radiology (L.S., R.S., G.L.C., R.C.), Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy; Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam (D.B.), University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC (D.B.), Rotterdam, the Netherlands; Department of Cardiovascular Sciences (D.B.), KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology (D.B.), Harvard School of Public Health, Boston, Massachusetts, USA; Institute for Stroke and Dementia Research (A.K.), University Hospital, LMU Munich, Munich, Germany; University of Washington Medical Center (M.M.B.), Seattle, Washington, USA; Department of Radiology (J.W.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Vascular Surgery(R.S), Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari—Polo di Monserrato, Cagliari, Italy; Institute of Neuroradiology (A.S.,T.S.), University Hospital, LMU Munich, Germany; Vascular Screening and Diagnostic Centre (A.N.N.), Nicosia, Cyprus; University of Nicosia Medical School (A.N.N.), Nicosia, Cyprus; Department of Vascular Surgery (A.N.N), Imperial College, London, United Kingdom; Department of Radiology and Nuclear Medicine (M.E.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota, USA
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Roberto Sanfilippo
From the Department of Radiology (L.S., R.S., G.L.C., R.C.), Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy; Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam (D.B.), University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC (D.B.), Rotterdam, the Netherlands; Department of Cardiovascular Sciences (D.B.), KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology (D.B.), Harvard School of Public Health, Boston, Massachusetts, USA; Institute for Stroke and Dementia Research (A.K.), University Hospital, LMU Munich, Munich, Germany; University of Washington Medical Center (M.M.B.), Seattle, Washington, USA; Department of Radiology (J.W.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Vascular Surgery(R.S), Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari—Polo di Monserrato, Cagliari, Italy; Institute of Neuroradiology (A.S.,T.S.), University Hospital, LMU Munich, Germany; Vascular Screening and Diagnostic Centre (A.N.N.), Nicosia, Cyprus; University of Nicosia Medical School (A.N.N.), Nicosia, Cyprus; Department of Vascular Surgery (A.N.N), Imperial College, London, United Kingdom; Department of Radiology and Nuclear Medicine (M.E.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota, USA
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Andreas Schindler
From the Department of Radiology (L.S., R.S., G.L.C., R.C.), Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy; Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam (D.B.), University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC (D.B.), Rotterdam, the Netherlands; Department of Cardiovascular Sciences (D.B.), KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology (D.B.), Harvard School of Public Health, Boston, Massachusetts, USA; Institute for Stroke and Dementia Research (A.K.), University Hospital, LMU Munich, Munich, Germany; University of Washington Medical Center (M.M.B.), Seattle, Washington, USA; Department of Radiology (J.W.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Vascular Surgery(R.S), Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari—Polo di Monserrato, Cagliari, Italy; Institute of Neuroradiology (A.S.,T.S.), University Hospital, LMU Munich, Germany; Vascular Screening and Diagnostic Centre (A.N.N.), Nicosia, Cyprus; University of Nicosia Medical School (A.N.N.), Nicosia, Cyprus; Department of Vascular Surgery (A.N.N), Imperial College, London, United Kingdom; Department of Radiology and Nuclear Medicine (M.E.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota, USA
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Andrew N. Nicolaides
From the Department of Radiology (L.S., R.S., G.L.C., R.C.), Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy; Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam (D.B.), University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC (D.B.), Rotterdam, the Netherlands; Department of Cardiovascular Sciences (D.B.), KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology (D.B.), Harvard School of Public Health, Boston, Massachusetts, USA; Institute for Stroke and Dementia Research (A.K.), University Hospital, LMU Munich, Munich, Germany; University of Washington Medical Center (M.M.B.), Seattle, Washington, USA; Department of Radiology (J.W.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Vascular Surgery(R.S), Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari—Polo di Monserrato, Cagliari, Italy; Institute of Neuroradiology (A.S.,T.S.), University Hospital, LMU Munich, Germany; Vascular Screening and Diagnostic Centre (A.N.N.), Nicosia, Cyprus; University of Nicosia Medical School (A.N.N.), Nicosia, Cyprus; Department of Vascular Surgery (A.N.N), Imperial College, London, United Kingdom; Department of Radiology and Nuclear Medicine (M.E.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota, USA
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M. Eline Kooi
From the Department of Radiology (L.S., R.S., G.L.C., R.C.), Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy; Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam (D.B.), University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC (D.B.), Rotterdam, the Netherlands; Department of Cardiovascular Sciences (D.B.), KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology (D.B.), Harvard School of Public Health, Boston, Massachusetts, USA; Institute for Stroke and Dementia Research (A.K.), University Hospital, LMU Munich, Munich, Germany; University of Washington Medical Center (M.M.B.), Seattle, Washington, USA; Department of Radiology (J.W.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Vascular Surgery(R.S), Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari—Polo di Monserrato, Cagliari, Italy; Institute of Neuroradiology (A.S.,T.S.), University Hospital, LMU Munich, Germany; Vascular Screening and Diagnostic Centre (A.N.N.), Nicosia, Cyprus; University of Nicosia Medical School (A.N.N.), Nicosia, Cyprus; Department of Vascular Surgery (A.N.N), Imperial College, London, United Kingdom; Department of Radiology and Nuclear Medicine (M.E.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota, USA
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Tobias Saam
From the Department of Radiology (L.S., R.S., G.L.C., R.C.), Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy; Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam (D.B.), University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC (D.B.), Rotterdam, the Netherlands; Department of Cardiovascular Sciences (D.B.), KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology (D.B.), Harvard School of Public Health, Boston, Massachusetts, USA; Institute for Stroke and Dementia Research (A.K.), University Hospital, LMU Munich, Munich, Germany; University of Washington Medical Center (M.M.B.), Seattle, Washington, USA; Department of Radiology (J.W.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Vascular Surgery(R.S), Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari—Polo di Monserrato, Cagliari, Italy; Institute of Neuroradiology (A.S.,T.S.), University Hospital, LMU Munich, Germany; Vascular Screening and Diagnostic Centre (A.N.N.), Nicosia, Cyprus; University of Nicosia Medical School (A.N.N.), Nicosia, Cyprus; Department of Vascular Surgery (A.N.N), Imperial College, London, United Kingdom; Department of Radiology and Nuclear Medicine (M.E.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota, USA
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Riccardo Cau
From the Department of Radiology (L.S., R.S., G.L.C., R.C.), Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy; Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam (D.B.), University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC (D.B.), Rotterdam, the Netherlands; Department of Cardiovascular Sciences (D.B.), KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology (D.B.), Harvard School of Public Health, Boston, Massachusetts, USA; Institute for Stroke and Dementia Research (A.K.), University Hospital, LMU Munich, Munich, Germany; University of Washington Medical Center (M.M.B.), Seattle, Washington, USA; Department of Radiology (J.W.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Vascular Surgery(R.S), Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari—Polo di Monserrato, Cagliari, Italy; Institute of Neuroradiology (A.S.,T.S.), University Hospital, LMU Munich, Germany; Vascular Screening and Diagnostic Centre (A.N.N.), Nicosia, Cyprus; University of Nicosia Medical School (A.N.N.), Nicosia, Cyprus; Department of Vascular Surgery (A.N.N), Imperial College, London, United Kingdom; Department of Radiology and Nuclear Medicine (M.E.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota, USA
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Giuseppe Lanzino
From the Department of Radiology (L.S., R.S., G.L.C., R.C.), Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy; Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam (D.B.), University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC (D.B.), Rotterdam, the Netherlands; Department of Cardiovascular Sciences (D.B.), KU Leuven, Leuven, Belgium; Department of Clinical Epidemiology (D.B.), Harvard School of Public Health, Boston, Massachusetts, USA; Institute for Stroke and Dementia Research (A.K.), University Hospital, LMU Munich, Munich, Germany; University of Washington Medical Center (M.M.B.), Seattle, Washington, USA; Department of Radiology (J.W.S), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Vascular Surgery(R.S), Azienda Ospedaliero-Universitaria (A.O.U.) di Cagliari—Polo di Monserrato, Cagliari, Italy; Institute of Neuroradiology (A.S.,T.S.), University Hospital, LMU Munich, Germany; Vascular Screening and Diagnostic Centre (A.N.N.), Nicosia, Cyprus; University of Nicosia Medical School (A.N.N.), Nicosia, Cyprus; Department of Vascular Surgery (A.N.N), Imperial College, London, United Kingdom; Department of Radiology and Nuclear Medicine (M.E.K.), Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota, USA
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ABSTRACT

BACKGROUND AND PURPOSE: Atherosclerotic disease of the carotid arteries is a major cause of ischemic stroke. Traditionally, the degree of stenosis has been regarded as the primary parameter for predicting stroke risk, but emerging evidence highlights the importance of carotid plaque composition and morphology. Recently, the Carotid Plaque-Reporting and Data System (RADS) has been introduced to standardize carotid plaque assessment beyond the degree of carotid stenosis. However, its reliability in routine radiological practice has yet to be established.

PURPOSE: This study assesses the inter-reader agreement, intra-reader agreement and learning curve associated with Carotid Plaque-RADS.

MATERIALS AND METHODS: In this retrospective study 500 subjects who underwent computed tomography angiography (CTA) for suspected carotid atherosclerosis were assessed. Three readers with varying experience levels in vascular imaging independently evaluated all CTAs in five blocks using Carotid Plaque-RADS. To assess the impact of reader experience and potential improvement over time, inter-reader agreement between the three pairs of readers was calculated for each block using Cohen’s kappa (κ), enabling a comparison of agreement sequentially across the blocks. Intra-reader agreement was calculated on a random block of 100 patients (192 carotid arteries).

RESULTS: After exclusion of low-quality exams, 490 patients were selected for analysis, but 46 carotids were excluded due to previous revascularization procedures. The remaining 934 carotid arteries were assessed. The agreement was substantial between Expert and Intermediate readers, ranging from κ=0.78 to κ=0.88, moderate between Intermediate and Beginner readers, ranging from κ=0.50 to κ=0.74, and between Expert and Beginner improved from substantial (κ=0.68) to almost optimal (κ=0.86) across blocks, indicating the effect of a learning curve. The inter-reader percent agreement was best for Plaque-RADS category 1-2-3 and poorest for 4. Intra-reader agreement was substantial for the Beginner (κ=0.77) and almost perfect for both the Intermediate and Expert readers (κ=0.88).

CONCLUSIONS: In the CTA application of the Carotid Plaque-RADS, inter-reader agreement is substantial to near perfect among experienced and intermediate readers, with a notable learning curve for beginners. Intra-reader agreement is almost perfect in experienced and intermediate readers, indicating consistency of their grading, ensuring data reproducibility using Plaque-RADS.

ABBREVIATIONS: RADS: Reporting and Data System; CTA: Computed Tomography Angiography; HU: Hounsfield Unit; IPH: Intra-plaque Hemorrhage; FC: Fibrous Cap; MWT: Maximum Wall Thickness; κ: Cohen’s kappa; LRNC: Lipid-Rich Necrotic Core

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Luca Saba, Roberta Scicolone, Gian Luca Chabert, Daniel Bos, Anna Kopczak, Mahmud Mossa-Basha, Jae W. Song, Roberto Sanfilippo, Andreas Schindler, Andrew N. Nicolaides, M. Eline Kooi, Tobias Saam, Riccardo Cau, Giuseppe Lanzino
Carotid Plaque-RADS: Inter-and intra-reader agreement and learning curve analysis in Computed Tomography Angiography
American Journal of Neuroradiology Apr 2025, ajnr.A8769; DOI: 10.3174/ajnr.A8769

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Accepted Manuscript
Carotid Plaque-RADS: Inter-and intra-reader agreement and learning curve analysis in Computed Tomography Angiography
Luca Saba, Roberta Scicolone, Gian Luca Chabert, Daniel Bos, Anna Kopczak, Mahmud Mossa-Basha, Jae W. Song, Roberto Sanfilippo, Andreas Schindler, Andrew N. Nicolaides, M. Eline Kooi, Tobias Saam, Riccardo Cau, Giuseppe Lanzino
American Journal of Neuroradiology Apr 2025, ajnr.A8769; DOI: 10.3174/ajnr.A8769
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