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To the Editor: In their study comparing magnetic resonance imaging (MRI) and computed tomography (CT) for detection of acute intracerebral hemorrhage in patients presenting with acute stroke symptoms,¹ Dr Kidwell and colleagues concluded that the 2 methods have equivalent accuracy. Although the reported level of raw agreement of 96% was very high, we believe that an alternate statistical approach would have been more appropriate and would have resulted in a more conservative level of agreement.

Given that in the final study design neither modality was considered to be a criterion standard, a statistic should have been used to summarize the findings rather than a McNemar test for proportions. Even though the level of raw agreement was very high, because the prevalence for detecting acute hemorrhage was low (14.5%), agreement between MRI and CT could have occurred 75.2% of the time by chance alone. Correcting for this chance agreement, the level . . . [Full Text of this Article]

Michael Eliasziw, PhD
eliasziw@ucalgary.ca
Departments of Community Health Sciences  and Clinical Neurosciences

Leslie Paddock-Eliasziw, RN
Department of Pathology
University of Calgary
Calgary, Alberta

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