Journal article
Inter-rater reliability of atherosclerotic plaque enhancement on 7 T vessel wall MRI: Comparison with quantitative analysis
Interventional neuroradiology
08/24/2025
DOI: 10.1177/15910199251368719
PMCID: PMC12375601
PMID: 40850749
Abstract
Objective
Intracranial plaque enhancement (IPE) is a potential biomarker of plaque vulnerability but lacks a standardized definition. While subjective assessment may be prone to observer variability, a voxel-based quantification method can detect subtle signal intensity (SI) changes. This study aimed to compare the inter-rater reliability of subjective IPE evaluation with that of a voxel-based quantification method.
Methods
Patients with stroke due to intracranial atherosclerosis were prospectively imaged using 7 T vessel wall magnetic resonance imaging. Two adjudicators independently assessed IPE, with discrepancies resolved by a third, experienced neuroradiologist. IPE distribution was quantified using a semiautomated method based on SI measurements from post-contrast T1-weighted images. The mean enhancement ratio was calculated for each plaque to assess gadolinium enhancement. Inter-rater reproducibility and the concordance between subjective and objective assessments were evaluated. Regression analysis was performed to identify plaque morphological features that influenced the reliability of subjective IPE adjudication compared to the objective method.
Results
We analyzed 75 plaques from 41 patients. Inter-rater agreement for IPE adjudication was poor (κ = 0.34). Following consensus, 43% of plaques (32/75) were classified as enhancing, whereas 57% (43/75) were non-enhancing. The agreement between subjective and objective IPE assessments was moderate (κ = 0.40, p < 0.001). Subjective assessment was more likely to reliably adjudicate IPE for plaques exhibiting >50% stenosis (odds ratio (OR), 1.04; p = 0.02) and a positive remodeling index (OR, 2.20; p = 0.02). In contrast, it was less reliable when evaluating posterior circulation plaques (OR, 0.23; p = 0.01).
Conclusion
Subjective assessment of IPE demonstrated poor inter-rater agreement and only moderate concordance with voxel-based quantification following consensus.
Details
- Title: Subtitle
- Inter-rater reliability of atherosclerotic plaque enhancement on 7 T vessel wall MRI: Comparison with quantitative analysis
- Creators
- Carlos Dier - University of IowaSultan Alhajahjeh - University of IowaAbdallah A Alqudah - Department of Radiology, University of Iowa, Iowa City, IA, USAAndres Gudino - University of IowaNavami Shenoy - University of IowaMartin A Cabarique - University of Iowa, NeurologyElena Sagues - University of IowaSebastian Sanchez - Yale UniversityConnor Aamot - University of IowaLinder Wendt - University of IowaBruno A Policeni - University of IowaMinako Hayakawa - University of IowaEdgar A Samaniego - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Interventional neuroradiology
- DOI
- 10.1177/15910199251368719
- PMID
- 40850749
- PMCID
- PMC12375601
- NLM abbreviation
- Interv Neuroradiol
- ISSN
- 1591-0199
- eISSN
- 2385-2011
- Publisher
- SAGE PUBLICATIONS INC
- Grant note
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa: 1S10RR028821-01
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Roy J. and Lucille A. Carver College of Medicine, University of Iowa, (grant number 1S10RR028821-01).
- Language
- English
- Electronic publication date
- 08/24/2025
- Academic Unit
- Neurology; Radiology; Oral Pathology, Radiology and Medicine; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
- Record Identifier
- 9984949229402771
Metrics
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