{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T06:29:38Z","timestamp":1787639378643,"version":"build-2736575974"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2020,1,31]],"date-time":"2020-01-31T00:00:00Z","timestamp":1580428800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,1,31]],"date-time":"2020-01-31T00:00:00Z","timestamp":1580428800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004063","name":"Knut och Alice Wallenbergs Stiftelse","doi-asserted-by":"publisher","award":["-"],"award-info":[{"award-number":["-"]}],"id":[{"id":"10.13039\/501100004063","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Region V\u00e4sterbotten","award":["-"],"award-info":[{"award-number":["-"]}]},{"name":"Research fund for neurological research at the university hospital of northern Sweden","award":["-"],"award-info":[{"award-number":["-"]}]},{"name":"The Swedish Stroke fund","award":["-"],"award-info":[{"award-number":["-"]}]},{"name":"The Northern Swedish Stroke fund","award":["-"],"award-info":[{"award-number":["-"]}]},{"name":"The Swedish Medical Association","award":["-"],"award-info":[{"award-number":["-"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>Assess the sensitivity and specificity of computed tomography angiography (CTA) for carotid near-occlusion diagnosis interpreted in clinical practice against expert assessment.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>CTAs were graded by two expert interpreters for near-occlusion. Findings were compared with clinical reports in 383 consecutive cases with symptomatic \u2265\u200950% carotid stenosis. In addition, 14 selected CTA exams (8 near-occlusions and 6 controls) were analyzed in a national effort by 13 radiologists experienced with carotid CTA.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>In clinical practice, imaging reports were 20% (95% CI 12\u201328%) sensitive for near-occlusion, ranging 0\u201358% between different radiologists; specificity was 99%. Among the 13 radiologists reviewing the same 8 near-occlusions, the average sensitivity was 8%, ranging 0\u201375%; specificity was 100%.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Carotid near-occlusion is systematically under-reported in clinical routine practice, caused by limited application of grading criteria when assessing CTA.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Key Points<\/jats:title>\n<jats:p>\u2022 <jats:italic>Carotid near-occlusion is severe stenosis with distal artery collapse; this collapse is often subtle.<\/jats:italic><\/jats:p>\n<jats:p>\u2022 <jats:italic>A fifth of near-occlusions were detected in routine practice. Many readers mistake near-occlusion for stenosis without distal artery collapse, either by not actively searching for subtle collapses or by not interpreting the collapse correctly when noticed.<\/jats:italic><\/jats:p>\n<jats:p>\u2022 <jats:italic>On the other hand, the novice diagnostician should be cautioned to not over-diagnose near-occlusion; other causes of extracranial ICA asymmetry also exist such as distal disease and Circle of Willis anatomical variants.<\/jats:italic><\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00330-019-06636-4","type":"journal-article","created":{"date-parts":[[2020,1,31]],"date-time":"2020-01-31T18:02:59Z","timestamp":1580493779000},"page":"2543-2551","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Carotid near-occlusion is often overlooked when CT angiography is assessed in routine practice"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5317-4563","authenticated-orcid":false,"given":"Elias","family":"Johansson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard I.","family":"Aviv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan J.","family":"Fox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,1,31]]},"reference":[{"key":"6636_CR1","doi-asserted-by":"publisher","first-page":"200","DOI":"10.3174\/ajnr.A4429","volume":"37","author":"E Johansson","year":"2016","unstructured":"Johansson E, Fox AJ (2016) Carotid near-occlusion: a comprehensive review, part 2\u2014prognosis and treatment, pathophysiology, confusions, and areas for improvement. 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An additional manuscript is planned for submission in parallel to current submission; topic is how often near-occlusions are detected on ultrasonography (a direct comparison CTA and numerical flow velocity findings, in contrast to current paper, where CTA interpretation is the topic).","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"value":"\u2022 Cross sectional study\u2022 Multicenter study","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}