{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T19:29:20Z","timestamp":1787945360741,"version":"build-2784847793"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Extracranial 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Of 151 patients included, 31 of 151 (20.5%) had extracranial ICA stenosis &gt;50%, and the average CDR was higher in patients with &gt;70% stenosis with threshold ratio of &gt;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%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Assessment 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/svin.125.002260","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T09:00:20Z","timestamp":1777626020000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Accuracy of Distal Internal Carotid Artery Contrast Ratio to Infer Proximal Carotid Disease in the Mobile Stroke Unit"],"prefix":"10.1161","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7579-0535","authenticated-orcid":true,"given":"James L.","family":"Barker","sequence":"first","affiliation":[{"name":"Department 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."},{"name":"Faculty of Medicine, Dentistry, and Health Sciences, Department of Medicine (J.L.B., H.T.J., L.C., A.B., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4610-1803","authenticated-orcid":true,"given":"Oshi","family":"Swarup","sequence":"additional","affiliation":[{"name":"Department of Neurology, Alfred Health, Melbourne, Victoria, Australia (O.S., A.H.B., C.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2135-0504","authenticated-orcid":true,"given":"Hannah T.","family":"Johns","sequence":"additional","affiliation":[{"name":"Department 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."},{"name":"Faculty of Medicine, Dentistry, and Health Sciences, Department of Medicine (J.L.B., H.T.J., L.C., A.B., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9807-6606","authenticated-orcid":true,"given":"Leonid","family":"Churilov","sequence":"additional","affiliation":[{"name":"Department 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."},{"name":"Faculty of Medicine, Dentistry, and Health Sciences, Department of Medicine (J.L.B., H.T.J., L.C., A.B., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3209-3101","authenticated-orcid":true,"given":"Anna H.","family":"Balabanski","sequence":"additional","affiliation":[{"name":"Department 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."},{"name":"Department of Neurology, Alfred Health, Melbourne, Victoria, Australia (O.S., A.H.B., C.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4952-8896","authenticated-orcid":true,"given":"Cameron","family":"Williams","sequence":"additional","affiliation":[{"name":"Department 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."},{"name":"Department of Neurology, Alfred Health, Melbourne, Victoria, Australia (O.S., A.H.B., C.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8802-9606","authenticated-orcid":true,"given":"Bernard","family":"Yan","sequence":"additional","affiliation":[{"name":"Department 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."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8337-7529","authenticated-orcid":true,"given":"Peter J.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Department of Radiology (P.J.M.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6614-8417","authenticated-orcid":true,"given":"Vincent N.","family":"Thijs","sequence":"additional","affiliation":[{"name":"Department of Neurology, Austin Health, Melbourne, Victoria, Australia (V.N.T.)."},{"name":"Stroke and Critical Care Research Priority, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (V.N.T.)."},{"name":"Department of Medicine, Austin Medical School, The University of Melbourne, Parkville, Victoria, Australia (V.N.T.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7762-5832","authenticated-orcid":true,"given":"Andrew","family":"Bivard","sequence":"additional","affiliation":[{"name":"Department 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."},{"name":"Faculty of Medicine, Dentistry, and Health Sciences, Department of Medicine (J.L.B., H.T.J., L.C., A.B., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1773-5332","authenticated-orcid":true,"given":"Francesca","family":"Langenberg","sequence":"additional","affiliation":[{"name":"Department 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."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4320-4287","authenticated-orcid":true,"given":"Henry","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department 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."},{"name":"Faculty of Medicine, Dentistry, and Health Sciences, Department of Medicine (J.L.B., H.T.J., L.C., A.B., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6324-3403","authenticated-orcid":true,"given":"Geoffrey A.","family":"Donnan","sequence":"additional","affiliation":[{"name":"Department 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."},{"name":"Faculty of Medicine, Dentistry, and Health Sciences, Department of Medicine (J.L.B., H.T.J., L.C., A.B., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0962-2300","authenticated-orcid":true,"given":"Stephen M.","family":"Davis","sequence":"additional","affiliation":[{"name":"Department 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."},{"name":"Faculty of Medicine, Dentistry, and Health Sciences, Department of Medicine (J.L.B., H.T.J., L.C., A.B., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3632-9433","authenticated-orcid":true,"given":"Bruce C.V.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department 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."},{"name":"Faculty of Medicine, Dentistry, and Health Sciences, Department of Medicine (J.L.B., H.T.J., L.C., A.B., H.Z., G.A.D., S.M.D., B.C.V.C.), The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)00537-2"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)00564-5"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.23522"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-021-05063-5"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2001123"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.23523"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01142-X"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/neurintsurg-2017-013707"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejro.2023.100513"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.20517\/2574-1209.2020.77"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/1591019919899755"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2018.01046"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2018.01171"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2021.1707"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/23969873251355158"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-021-10876-0"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h5527"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001081.pub4"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.21037\/qims-24-834"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A3666"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1148\/ryai.220232"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1037\/\/0033-2909.86.2.420"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.13647"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.106086"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2021.2385"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.592535"}],"container-title":["Stroke: Vascular and Interventional Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/SVIN.125.002260","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T13:43:49Z","timestamp":1783691029000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/SVIN.125.002260"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":26,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1161\/SVIN.125.002260"],"URL":"https:\/\/doi.org\/10.1161\/svin.125.002260","relation":{},"ISSN":["2694-5746"],"issn-type":[{"value":"2694-5746","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2025-11-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-20","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-19","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}