{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T13:18:23Z","timestamp":1769087903701,"version":"3.49.0"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Differentiating true from pseudo-occlusion of the cervical internal carotid artery (ICA) in acute ischemic stroke patients undergoing thrombectomy is crucial but challenging. We aimed to investigate the ability of contrast-enhanced magnetic resonance angiography (CE-MRA) to differentiate true from pseudo-occlusion (defined as an isolated thrombus of the intracranial ICA suppressing ascending blood flow) of the cervical ICA in acute ischemic stroke patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Multicenter, retrospective analysis of acute ischemic stroke patients with true or pseudo-occlusion of the cervical ICA and subsequent thrombectomy. Patients with preprocedural CE-MRA showing a lack of contrast filling in the cervical ICA on the symptomatic side were included. Six readers (three radiology fellows and three board-certified radiologists) independently evaluated the CE-MRA images for true or pseudo-occlusion of the cervical ICA using a rating scheme. Their assessments were compared with DSA results as the reference standard. Diagnostic accuracy measures, as well as inter- and intra-reader reliability for detecting pseudo-occlusion, were calculated and compared between subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 41 patients were included. The median age was 73\u2009years, and 39% were female. According to the reference standard, 16 of 41 (39%) patients had a pseudo-occlusion of the cervical ICA, while the remainder had a true occlusion. The aggregated sensitivity and specificity from all readers were 72% (95% confidence interval [CI]: 62%\u201381%) and 86% (95% CI: 79%\u201391%), respectively. Board-certified radiologists performed better, with a sensitivity of 81% (95% CI: 67%\u201391%) and specificity of 92% (95% CI: 83%\u201397%). Overall, inter-reader agreement was moderate (\u03ba\u2009=\u20090.48; 95% CI: 0.31\u20130.65) and reached substantial agreement within the board-certified radiologists subgroup (\u03ba\u2009=\u20090.65; 95% CI: 0.45\u20130.85).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Differentiating true occlusion from pseudo-occlusion of the cervical ICA using CE-MRA is feasible but requires training in specific imaging characteristics as well as experience in interpreting them, as evidenced by the higher diagnostic accuracy of board-certified radiologists. Correct distinction help in optimal material selection (e.g. size and type of guiding catheter) prior to endovascular treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/esj\/23969873251355450","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T11:01:53Z","timestamp":1768906913000},"source":"Crossref","is-referenced-by-count":0,"title":["True versus pseudo-occlusion of the cervical internal carotid artery in acute stroke: A multicenter MR angiography study"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8988-0918","authenticated-orcid":false,"given":"Christian","family":"Heitkamp","sequence":"first","affiliation":[{"name":"Department of Neuroradiology , University Medical Center Hamburg-Eppendorf, Hamburg ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pia","family":"Niederau","sequence":"additional","affiliation":[{"name":"Department of Radiology and Neuroradiology , University Hospital Cologne, Cologne ,","place":["Germany"]},{"name":"Department of Radiology and Neuroradiology , Lucerne Cantonal Hospital, Lucerne ,","place":["Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arndt-Hendrik","family":"Schievelkamp","sequence":"additional","affiliation":[{"name":"Department of Radiology and Neuroradiology , University Hospital Cologne, Cologne ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaos","family":"Ntoulias","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology , University Hospital Basel, Basel ,","place":["Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"Goertz","sequence":"additional","affiliation":[{"name":"Department of Radiology and Neuroradiology , University Hospital Cologne, Cologne ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Zopfs","sequence":"additional","affiliation":[{"name":"Department of Radiology and Neuroradiology , University Hospital Cologne, Cologne ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai R","family":"Laukamp","sequence":"additional","affiliation":[{"name":"Department of Radiology and Neuroradiology , University Hospital Cologne, Cologne ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Sch\u00f6mig","sequence":"additional","affiliation":[{"name":"Department of Radiology and Neuroradiology , University Hospital Cologne, Cologne ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Kottlors","sequence":"additional","affiliation":[{"name":"Department of Radiology and Neuroradiology , University Hospital Cologne, Cologne 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