{"pk":13258,"title":"Assessment of Vessel Density on Non-Contrast Computed Tomography to Detect Basilar Artery Occlusion","subtitle":null,"abstract":"Introduction:\n Basilar artery occlusion (BAO) may be clinically occult due to variable and non-specific symptomatology. We evaluated the qualitative and quantitative determination of a hyperdense basilar artery (HDBA) on non-contrast computed tomography (NCCT) brain for the diagnosis of BAO.\nMethods: \nWe conducted a case control study of patients with confirmed acute BAO vs a control group of suspected acute stroke patients without BAO. Two EM attending physicians, one third-year EM resident, and one medical student performed qualitative and quantitative assessments for the presence of a HDBA on axial NCCT images. Our primary outcome measures were sensitivity and specificity for BAO. Our secondary outcomes were inter-rater and intra-rater reliability of the qualitative and quantitative assessments.\nResults: \nWe included 60 BAO and 65 control patients in our analysis. Qualitative assessment of the hyperdense basilar artery sign was poorly sensitive (54%–72%) and specific (55%–89%). Quantitative measurement improved the specificity of hyperdense basilar artery assessment for diagnosing BAO, with a threshold of 61.0–63.8 Hounsfield units demonstrating relatively high specificity of 85%–94%. There was moderate inter-rater agreement for the qualitative assessment of HDBA (Fleiss’ kappa statistic 0.508, 95% confidence interval: 0.435–0.581). Agreement improved for quantitative assessments, but still fell in the moderate range (Shrout-Fleiss intraclass correlation coefficient: 0.635). Intra-rater reliability for the quantitative assessments of the two attending physician reviewers demonstrated substantial consistency.\nConclusion: \nOur results highlight the importance of carefully examining basilar artery density when interpreting the NCCT of patients with altered consciousness or other signs and symptoms concerning for an acute basilar artery occlusion. If the Hounsfield unit density of the basilar artery exceeds 61 Hounsfield units, BAO should be highly suspected.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Basilar Artery"},{"word":"stroke"},{"word":"Tomography, X-Ray Computed"},{"word":"Emergency Medicine"}],"section":"Critical Care","is_remote":true,"remote_url":"https://escholarship.org/uc/item/3549m832","frozenauthors":[{"first_name":"Andrew","middle_name":"W.","last_name":"Asimos","name_suffix":"","institution":"Atrium Health’s Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina","department":"None"},{"first_name":"D.","middle_name":"Richard","last_name":"Sassano","name_suffix":"","institution":"Brody School of Medicine at East Carolina University, Greenville, North Carolina","department":"None"},{"first_name":"Stephen","middle_name":"C.","last_name":"Jackson","name_suffix":"","institution":"Atrium Health’s Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina","department":"None"},{"first_name":"Jonathan","middle_name":"D.","last_name":"Clemente","name_suffix":"","institution":"Atrium Health’s Carolinas Medical Center, Department of Radiology, Charlotte, North Carolina","department":"None"},{"first_name":"Jeremy","middle_name":"B.","last_name":"Rhoten","name_suffix":"","institution":"Atrium Health’s Carolinas Medical Center, Department of Neurosciences, Charlotte, North Carolina","department":"None"},{"first_name":"Brenda","middle_name":"","last_name":"Chang","name_suffix":"","institution":"Atrium Health, Information and Analytics Services, Charlotte, North Carolina","department":"None"},{"first_name":"Michael","middle_name":"S.","last_name":"Runyon","name_suffix":"","institution":"Atrium Health’s Carolinas Medical Center, Department of Emergency Medicine, Charlotte, North Carolina","department":"None"}],"date_submitted":"2019-09-17T01:20:21Z","date_accepted":"2019-09-17T01:20:21Z","date_published":"2020-04-13T22:02:17Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13258/galley/6982/download/"}]}