Introduction: Since mechanical thrombectomy was established as the gold standard for treatment of stroke caused by an emergent large vessel occlusion (ELVO), comprehensive stroke centers have worked to streamline their workflow and minimize time-to-intervention; the ability to rapidly review CT angiography (CTA) is one hurdle in that process. To that end, we evaluated the diagnostic accuracy and confidence in review of CTA of the head and neck for ELVO via a smartphone-based application (LifeImage) as compared to review on a PACS workstation.
Methods: Seventy-six head and neck CTA studies performed for potential stroke from one comprehensive and seven primary stroke centers were independently reviewed remotely on smartphone by two blinded neurointerventional radiologists in actual-use circumstances. The presence and location of large vessel occlusion(s), diagnostic quality, and confidence in interpretation were recorded. Comparison was made to blinded review of these studies on a PACS workstation performed at a delayed interval. Kappa statistics were calculated to evaluate intra- and inter-observer reliability.
Results: Over 76 studies, occlusion of the M1 segment was demonstrated in 14 (18%); carotid artery in 2 (3%); tandem carotid and M1 in 2 (3%); basilar artery in 2 (3%); and no large vessel occlusion in 56 (73%). There was complete agreement between CTA interpretations on smartphone and on PACS with excellent intra- and inter-observer reliability (Table 1). No ELVOs were missed on smartphone review of these studies.
Conclusion: In actual-use circumstances, experienced neurointerventional radiologists are able to utilize a smartphone application to diagnose an ELVO on CTA as accurately as on a PACS workstation with similar levels of confidence. These findings support the use of mobile electronic devices by stroke networks to rapidly triage patients for mechanical thrombectomy.