The missing button sign as a tool for detecting proximal internal carotid artery occlusion

Jun Young Choi; Eun Jin Kim; Ho Sung Kim; In Soo Joo; Kyoon Huh; Phil Hyu Lee; Ji Hoe Heo; Hyo Suk Nam

doi:10.1016/j.jocn.2010.03.050

The missing button sign as a tool for detecting proximal internal carotid artery occlusion

Jun Young Choi, Eun Jin Kim, Ho Sung Kim, In Soo Joo, Kyoon Huh, Phil Hyu Lee, Ji Hoe Heo, Hyo Suk Nam

Department of Neurology

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

The aim of this study was to develop a simple and reliable sign for detecting proximal internal carotid artery occlusion (ICAO) using conventional CT scanning. The missing button sign (MBS) is defined as the absence of the ICA at the level of the foramen magnum on contrast-enhanced CT (CECT) scans. Two raters independently reviewed random CECT samples from consecutive patients with acute ischaemic stroke. A total of 399 patients with 798 carotid arteries were analysed. Rater A identified the MBS in 41 (5%) of the carotid arteries, and did not identify the MBS in 735 (92%) carotid arteries. Rater B identified the MBS in 45 (6%) of the arteries, and lack of the MBS in 731 (91%) arteries. The kappa value for agreement was 0.90 (95% CI 0.84-0.95). Compared with CT angiography, Rater A's sensitivity, specificity, positive predictive value, and negative predictive value for detecting proximal ICAO were 85%, 100%, 100%, and 99%, respectively, while Rater B's values were 87%, 99%, 93%, and 99%, respectively. This study indicated that the MBS on CECT scanning is both a consistent and specific tool for the early identification of proximal ICAO.

Original language	English
Pages (from-to)	1506-1509
Number of pages	4
Journal	Journal of Clinical Neuroscience
Volume	17
Issue number	12
DOIs	https://doi.org/10.1016/j.jocn.2010.03.050
Publication status	Published - 2010 Dec

Bibliographical note

Funding Information:
This work was supported by a grant from the Korea Government Ministry of Education, Science and Technology under Grant 2009-0069165 and a faculty research grant of Yonsei University College of Medicine for 2009 ( 6-2009-0130 ). The authors are grateful to Mr Dong-Su Jang (Yonsei University) for providing the illustration in Fig. 1 .

All Science Journal Classification (ASJC) codes

Surgery
Neurology
Clinical Neurology
Physiology (medical)

Access to Document

10.1016/j.jocn.2010.03.050

Cite this

@article{853b1e90412f4925a796235c03e5ac39,

title = "The missing button sign as a tool for detecting proximal internal carotid artery occlusion",

abstract = "The aim of this study was to develop a simple and reliable sign for detecting proximal internal carotid artery occlusion (ICAO) using conventional CT scanning. The missing button sign (MBS) is defined as the absence of the ICA at the level of the foramen magnum on contrast-enhanced CT (CECT) scans. Two raters independently reviewed random CECT samples from consecutive patients with acute ischaemic stroke. A total of 399 patients with 798 carotid arteries were analysed. Rater A identified the MBS in 41 (5%) of the carotid arteries, and did not identify the MBS in 735 (92%) carotid arteries. Rater B identified the MBS in 45 (6%) of the arteries, and lack of the MBS in 731 (91%) arteries. The kappa value for agreement was 0.90 (95% CI 0.84-0.95). Compared with CT angiography, Rater A's sensitivity, specificity, positive predictive value, and negative predictive value for detecting proximal ICAO were 85%, 100%, 100%, and 99%, respectively, while Rater B's values were 87%, 99%, 93%, and 99%, respectively. This study indicated that the MBS on CECT scanning is both a consistent and specific tool for the early identification of proximal ICAO.",

author = "Choi, {Jun Young} and Kim, {Eun Jin} and Kim, {Ho Sung} and Joo, {In Soo} and Kyoon Huh and Lee, {Phil Hyu} and Heo, {Ji Hoe} and Nam, {Hyo Suk}",

note = "Funding Information: This work was supported by a grant from the Korea Government Ministry of Education, Science and Technology under Grant 2009-0069165 and a faculty research grant of Yonsei University College of Medicine for 2009 ( 6-2009-0130 ). The authors are grateful to Mr Dong-Su Jang (Yonsei University) for providing the illustration in Fig. 1 .",

year = "2010",

month = dec,

doi = "10.1016/j.jocn.2010.03.050",

language = "English",

volume = "17",

pages = "1506--1509",

journal = "Journal of Clinical Neuroscience",

issn = "0967-5868",

publisher = "Churchill Livingstone",

number = "12",

}

TY - JOUR

T1 - The missing button sign as a tool for detecting proximal internal carotid artery occlusion

AU - Choi, Jun Young

AU - Kim, Eun Jin

AU - Kim, Ho Sung

AU - Joo, In Soo

AU - Huh, Kyoon

AU - Lee, Phil Hyu

AU - Heo, Ji Hoe

AU - Nam, Hyo Suk

N1 - Funding Information: This work was supported by a grant from the Korea Government Ministry of Education, Science and Technology under Grant 2009-0069165 and a faculty research grant of Yonsei University College of Medicine for 2009 ( 6-2009-0130 ). The authors are grateful to Mr Dong-Su Jang (Yonsei University) for providing the illustration in Fig. 1 .

PY - 2010/12

Y1 - 2010/12

N2 - The aim of this study was to develop a simple and reliable sign for detecting proximal internal carotid artery occlusion (ICAO) using conventional CT scanning. The missing button sign (MBS) is defined as the absence of the ICA at the level of the foramen magnum on contrast-enhanced CT (CECT) scans. Two raters independently reviewed random CECT samples from consecutive patients with acute ischaemic stroke. A total of 399 patients with 798 carotid arteries were analysed. Rater A identified the MBS in 41 (5%) of the carotid arteries, and did not identify the MBS in 735 (92%) carotid arteries. Rater B identified the MBS in 45 (6%) of the arteries, and lack of the MBS in 731 (91%) arteries. The kappa value for agreement was 0.90 (95% CI 0.84-0.95). Compared with CT angiography, Rater A's sensitivity, specificity, positive predictive value, and negative predictive value for detecting proximal ICAO were 85%, 100%, 100%, and 99%, respectively, while Rater B's values were 87%, 99%, 93%, and 99%, respectively. This study indicated that the MBS on CECT scanning is both a consistent and specific tool for the early identification of proximal ICAO.

AB - The aim of this study was to develop a simple and reliable sign for detecting proximal internal carotid artery occlusion (ICAO) using conventional CT scanning. The missing button sign (MBS) is defined as the absence of the ICA at the level of the foramen magnum on contrast-enhanced CT (CECT) scans. Two raters independently reviewed random CECT samples from consecutive patients with acute ischaemic stroke. A total of 399 patients with 798 carotid arteries were analysed. Rater A identified the MBS in 41 (5%) of the carotid arteries, and did not identify the MBS in 735 (92%) carotid arteries. Rater B identified the MBS in 45 (6%) of the arteries, and lack of the MBS in 731 (91%) arteries. The kappa value for agreement was 0.90 (95% CI 0.84-0.95). Compared with CT angiography, Rater A's sensitivity, specificity, positive predictive value, and negative predictive value for detecting proximal ICAO were 85%, 100%, 100%, and 99%, respectively, while Rater B's values were 87%, 99%, 93%, and 99%, respectively. This study indicated that the MBS on CECT scanning is both a consistent and specific tool for the early identification of proximal ICAO.

UR - http://www.scopus.com/inward/record.url?scp=78049460954&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78049460954&partnerID=8YFLogxK

U2 - 10.1016/j.jocn.2010.03.050

DO - 10.1016/j.jocn.2010.03.050

M3 - Article

C2 - 20817467

AN - SCOPUS:78049460954

SN - 0967-5868

VL - 17

SP - 1506

EP - 1509

JO - Journal of Clinical Neuroscience

JF - Journal of Clinical Neuroscience

IS - 12

ER -

The missing button sign as a tool for detecting proximal internal carotid artery occlusion

Abstract

Bibliographical note

All Science Journal Classification (ASJC) codes

Access to Document

Other files and links

Fingerprint

Cite this