BackgroundArtificial intelligence (AI) software is increasingly applied in stroke diagnostics. However, the actual performance of AI tools for identifying large vessel occlusion (LVO) stroke in real time in a real-world setting has not been fully studied.ObjectiveTo determine the accuracy of AI software in a real-world, three-tiered multihospital stroke network.MethodsAll consecutive head and neck CT angiography (CTA) scans performed during stroke codes and run through an AI software engine (Viz LVO) between May 2019 and October 2020 were prospectively collected. CTA readings by radiologists served as the clinical reference standard test and Viz LVO output served as the index test. Accuracy metrics were calculated.ResultsOf a total of 1822 CTAs performed, 190 occlusions were identified; 142 of which were internal carotid artery terminus (ICA-T), middle cerebral artery M1, or M2 locations. Accuracy metrics were analyzed for two different groups: ICA-T and M1 ±M2. For the ICA-T/M1 versus the ICA-T/M1/M2 group, sensitivity was 93.8% vs 74.6%, specificity was 91.1% vs 91.1%, negative predictive value was 99.7% vs 97.6%, accuracy was 91.2% vs 89.8%, and area under the curve was 0.95 vs 0.86, respectively. Detection rates for ICA-T, M1, and M2 occlusions were 100%, 93%, and 49%, respectively. As expected, the algorithm offered better detection rates for proximal occlusions than for mid/distal M2 occlusions (58% vs 28%, p=0.03).ConclusionsThese accuracy metrics support Viz LVO as a useful adjunct tool in stroke diagnostics. Fast and accurate diagnosis with high negative predictive value mitigates missing potentially salvageable patients.
Objective Pituitary adenomas are historically classified into microadenoma or macroadenomas based on size less than or greater than/equal to 1c m. “Giant” adenomas describe tumors ≥4 cm. The aim of this study is to present an evidence-based approach to size classification based on national trends. Design The design involved is multi-institutional retrospective study. Participants A total of 29,651 patients were studied from National Cancer Institute's SEER program from 2004 to 2016 across the United States. Main Outcome Measures The main outcome measures include demographics, treatment characteristics, and overall survival in the population. Results At the 20-mm threshold, the likelihood of operation exceeds the likelihood of nonoperative management. Patients with adenoma size 1 to 19 mm had significantly longer overall survival compared with 20 to 50 mm (Log rank: p < 0.0001). No survival difference was found between size 20 to 29 mm and larger. There was no significant difference in the rate of surgery between 30 to 39 mm and 40 to 50 mm tumors(p = 0.5035). Surgery group had a higher overall survival compared with nonsurgically managed patients (Log rank: p < 0.0001). Conclusion Microadenoma has classically been used to describe pituitary tumors less than 1 cm, though no clinical significance of this threshold has been demonstrated. The current study suggests a size cut-off of 20 or 30 mm as more clinically relevant. Still, future studies are warranted to examine the significance of this classification by specific tumor type, and subclassified as appropriate. There is no difference in the rate of surgery or survival for adenomas between 30 and 50 mm, challenging the 4-mm cutoff threshold for “giant” adenoma.
BACKGROUND AND PURPOSE: Two-thirds of lymphatic malformations in children are found in the head and neck. Although conventionally managed through surgical resection, percutaneous sclerotherapy has gained popularity. No reproducible grading system has been designed to compare sclerotherapy outcomes on the basis of radiologic findings. We propose an MR imaging-based grading scale to assess the response to sclerotherapy and present an evaluation of its interrater reliability. MATERIALS AND METHODS:A grading system was developed to stratify treatment outcomes on the basis of interval changes observed on MR imaging. By means of this system, 56 consecutive cases from our institution with formally diagnosed head and neck lymphatic malformations treated by sclerotherapy were retrospectively graded. Each patient underwent pre-and posttreatment MR imaging. Each study was evaluated by 3 experienced neuroradiologists. Interrater reliability was assessed using the Krippendorff a statistic, intraclass coefficient, and 2-way Spearman r correlation. RESULTS:The overall Krippendorff a statistic was 0.93 (95% CI, 0.89-0.95), denoting excellent agreement among raters. Intraclass coefficients with respect to consistency and absolute agreements were both 0.97 (95% CI, 0.96-0.98), illustrating low variability. Every combination of individual rater pairs demonstrated statistically significant (P , .01) linear Spearman r correlations, with values ranging from 0.90 to 0.95. CONCLUSIONS:The proposed radiographic grading scale demonstrates excellent interrater reliability. Adoption of this new scale can standardize reported outcomes following sclerotherapy for head and neck lymphatic malformation and may aid in the investigation of future questions regarding optimal management of these lesions.
Introduction: In New York City (NYC), expanding the reach of thrombectomy-capable stroke centers (TSC) is key to combating socioeconomic disparities in stroke care. The Area Deprivation Index (ADI), a validated, neighborhood-level composite measure (scored 1-100) that includes income, education, employment, and housing quality, has informed healthcare delivery but has not been used to identify disadvantaged neighborhoods with poor access to stroke care. We sought to evaluate the impact of establishing Mount Sinai Queens Hospital (MSQ) as a TSC in 2017 on transfer times and to explore the association between ADI and stroke care access. Methods: Thrombectomy patient pick-up addresses were obtained through Emergency Medical Services runsheets from June 2016 to July 2021 and matched to census-tract level ADI scores from Neighborhood Atlas. Preliminary analyses compared both ADIs and time to stroke care access in both Queens and Manhattan. The primary outcome measure was the duration between ambulance arrival and groin puncture. Simple linear regression and T-tests were used to assess the association between ADI and time to groin puncture by borough. Results: Among 517 cases between 2016-2021, the average ADI of pick-up locations was 10.35 (range: 1 - 70.5). Across all centers, higher ADI (greater deprivation) was significantly associated with increased time to groin puncture (p = 0.024). Notably, Queens patients were picked up in census tracts with higher ADI (p=0.0289) but had a faster pick up to groin puncture time (p=0.006). Conclusions: Across urban census tracts, a higher ADI was associated with delays in access to thrombectomy. Thrombectomy centers in areas with higher ADI can play a role in reducing healthcare disparities for stroke patients.
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