Evidence map›Paper›PMID 42404831›Full record

ArticleStroke (Hoboken, N.J.)2026

Accuracy of Distal Internal Carotid Artery Contrast Ratio to Infer Proximal Carotid Disease in the Mobile Stroke Unit.

James L Barker, Oshi Swarup, Hannah T Johns, Leonid Churilov, Anna H Balabanski, Cameron Williams, Bernard Yan, Peter J Mitchell, Vincent N Thijs, Andrew Bivard and 5 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Stroke (Hoboken, N.J.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

James L BarkerDepartment of Neurology, Melbourne Brain Centre (J.L.B., H.T.J., L.C., A.H.B., C.W., B.Y., A.B., F.L., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.ORCID https://orcid.org/0000-0001-7579-0535
Oshi SwarupDepartment of Neurology, Alfred Health, Melbourne, Victoria, Australia (O.S., A.H.B., C.W.).ORCID https://orcid.org/0000-0003-4610-1803
Hannah T JohnsDepartment of Neurology, Melbourne Brain Centre (J.L.B., H.T.J., L.C., A.H.B., C.W., B.Y., A.B., F.L., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.ORCID https://orcid.org/0000-0003-2135-0504
Leonid ChurilovDepartment of Neurology, Melbourne Brain Centre (J.L.B., H.T.J., L.C., A.H.B., C.W., B.Y., A.B., F.L., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.ORCID https://orcid.org/0000-0002-9807-6606
Anna H BalabanskiDepartment of Neurology, Melbourne Brain Centre (J.L.B., H.T.J., L.C., A.H.B., C.W., B.Y., A.B., F.L., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.ORCID https://orcid.org/0000-0003-3209-3101
Cameron WilliamsDepartment of Neurology, Melbourne Brain Centre (J.L.B., H.T.J., L.C., A.H.B., C.W., B.Y., A.B., F.L., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.ORCID https://orcid.org/0000-0003-4952-8896
Bernard YanDepartment of Neurology, Melbourne Brain Centre (J.L.B., H.T.J., L.C., A.H.B., C.W., B.Y., A.B., F.L., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.ORCID https://orcid.org/0000-0001-8802-9606
Peter J MitchellDepartment of Radiology (P.J.M.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.ORCID https://orcid.org/0000-0002-8337-7529
Vincent N ThijsDepartment of Neurology, Austin Health, Melbourne, Victoria, Australia (V.N.T.).ORCID https://orcid.org/0000-0002-6614-8417
Andrew BivardDepartment of Neurology, Melbourne Brain Centre (J.L.B., H.T.J., L.C., A.H.B., C.W., B.Y., A.B., F.L., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.ORCID https://orcid.org/0000-0001-7762-5832
Francesca LangenbergDepartment of Neurology, Melbourne Brain Centre (J.L.B., H.T.J., L.C., A.H.B., C.W., B.Y., A.B., F.L., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.ORCID https://orcid.org/0000-0002-1773-5332
Henry ZhaoDepartment of Neurology, Melbourne Brain Centre (J.L.B., H.T.J., L.C., A.H.B., C.W., B.Y., A.B., F.L., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.ORCID https://orcid.org/0000-0002-4320-4287
Geoffrey A DonnanDepartment of Neurology, Melbourne Brain Centre (J.L.B., H.T.J., L.C., A.H.B., C.W., B.Y., A.B., F.L., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.ORCID https://orcid.org/0000-0001-6324-3403
Stephen M DavisDepartment of Neurology, Melbourne Brain Centre (J.L.B., H.T.J., L.C., A.H.B., C.W., B.Y., A.B., F.L., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.ORCID https://orcid.org/0000-0003-0962-2300
Bruce C V CampbellDepartment of Neurology, Melbourne Brain Centre (J.L.B., H.T.J., L.C., A.H.B., C.W., B.Y., A.B., F.L., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.ORCID https://orcid.org/0000-0003-3632-9433

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundExtracranial internal carotid artery (ICA) stenosis is a common cause of ischemic stroke and transient ischemic attack. Cervical computed tomography (CT) angiography can rapidly diagnose carotid pathology but is not possible with current-generation CT scanners used in mobile stroke units. We assessed the diagnostic accuracy of the intracranial ICA contrast density ratio (CDR) to identify extracranial ICA stenosis.

methodsWe retrospectively reviewed consecutive patients at 3 comprehensive stroke centers in Melbourne, Victoria, who received CT angiography on the mobile stroke unit CereTom CT scanner, with reference standard in-hospital CT angiography or digital subtraction angiography in the Melbourne mobile stroke unit database. The mean Hounsfield units at 4 segments of the intracranial ICA, both ipsilateral and contralateral to the symptomatic hemisphere, were measured. The CDR was calculated using the formula: CDR=contralateral mean Hounsfield units/ipsilateral Hounsfield units. Statistical analysis was completed with univariate analysis of CDR, and leave-one-out cross-validation with receiver operating characteristic area under the curve to determine CDR thresholds associated with stenosis or occlusion, to determine sensitivity and specificity of the test.

resultsOf 151 patients included, 31 of 151 (20.5%) had extracranial ICA stenosis >50%, and the average CDR was higher in patients with >70% stenosis with threshold ratio of >1.24 (sensitivity, 80%; specificity, 88%; positive predictive value, 57%; and negative predictive value, 96%) or extracranial occlusion (sensitivity, 100; specificity, 82%; positive predictive value, 29%; and negative predictive value, 100%). The threshold of 1.18 for 50% to 99% and carotid occlusion had lower sensitivity (sensitivity, 78%; specificity, 95%; positive predictive value, 88%; and negative predictive value, 91%).

conclusionsAssessment of the intracranial ICA CDR may assist in ruling out high-grade extracranial stenosis in patients who are being considered for direct transfer for endovascular thrombectomy after head-only CT angiography.

Indexed as

carotid stenosiscomputed tomography angiographyischemic strokestents

Identifiers

PMID42404831
PMCPMC13331385

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