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AJNR Am J Neuroradiol. 2012 Apr;33(4):626-31. doi: 10.3174/ajnr.A2848. Epub 2011 Dec 22.

Outcomes of endovascular treatments of aneurysms: observer variability and implications for interpreting case series and planning randomized trials.

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1
Department of Neuroradiology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.

Abstract

BACKGROUND AND PURPOSE:

Angiographic results are commonly used as a surrogate marker of success of coiling of intracranial aneurysms. Inter- and intraobserver agreement in judging angiographic results remain poorly characterized. Our goal was to offer such an evaluation of a grading scale commonly used to evaluate results of endovascular treatment of aneurysms.

MATERIALS AND METHODS:

A portfolio of 90 angiographic images from 45 patients selected from the core lab data base of a randomized trial was sent to 12 observers on 2 occasions more than 3 months apart. The variability of a 3-value grading scale used to score angiographic results and of a final judgment regarding the presence of a recurrence was studied using κ statistics.

RESULTS:

Ten participants responded once and 6 responded twice. Agreement was poor to moderate (κ = 0.28-0.5) for senior and junior observers judging angiographic results immediately or 12-18 months after treatment. Agreement reached a reassuring "substantial" (κ = 0.62) level, with a dichotomous presence-absence of a major recurrence, and intraobserver agreement was better in experienced core lab assessors.

CONCLUSIONS:

There is an important variability in the assessment of angiographic outcomes of endovascular treatments, rendering comparisons between publications risky, if not invalid. A simple dichotomous judgment can be used as a surrogate outcome in randomized trials designed to assess the value of new endovascular devices.

PMID:
22194386
DOI:
10.3174/ajnr.A2848
[Indexed for MEDLINE]
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