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World Neurosurg. 2017 Jul;103:876-882.e1. doi: 10.1016/j.wneu.2017.04.131. Epub 2017 Apr 28.

Interrater Agreement in the Radiologic Characterization of Ruptured Intracranial Aneurysms Based on Computed Tomography Angiography.

Author information

1
Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland. Electronic address: nicolai.maldaner@usz.ch.
2
Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland; Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland.
3
Department of Neurosurgery, University Clinic Geneva, Geneva, Switzerland.
4
Department of Neurosurgery, Basel University Hospital, Basel, Switzerland.
5
Department of Neurosurgery, Basel University Hospital, Basel, Switzerland; Section for Diagnostic and Interventional Neuroradiology, Department of Radiology, Basel University Hospital, Basel, Switzerland.
6
Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
7
Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
8
Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.

Abstract

OBJECTIVE:

To determine interrater agreement in the initial radiologic characterization of ruptured intracranial aneurysms based on computed tomography angiography (CTA) with special emphasis on the rater's level of experience.

METHODS:

One junior and one senior rater of 5 high-volume neurovascular tertiary centers evaluated anonymized CTA images of 30 consecutive patients with aneurysmal subarachnoid hemorrhage. Each rater described location, side, size, and morphology in a standardized manner. Interrater variability was analyzed using intraclass correlation and Fleiss' kappa analysis.

RESULTS:

There was a high level of agreement for location (κ = 0.76, 95% confidence interval [CI] 0.74-0.79), side (κ = 0.95, CI 0.91-0.99), maximum diameter (intraclass correlation coefficient [ICC] 0.81, CI 0.70-0.90), and dome (ICC 0.78, CI 0.66-0.88) of intracranial aneurysms. In contrast, a lower level of agreement was observed for aneurysms' neck diameter (ICC 0.39, CI 0.28-0.58), the presence of multiple aneurysms (κ = 0.35, CI 0.30-0.40), and aneurysm morphology (blister κ = 0.11, CI -0.05 to 0.07; fusiform κ = 0.54, CI 0.48-0.60; multilobular, κ = 0.39 CI 0.33-0.45). The interrater agreement in the senior rater group was greater than in the junior rater group.

CONCLUSIONS:

Interrater agreement confirms the benefit of CTA as initial diagnostic imaging in ruptured intracranial aneurysms but not for aneurysm morphology and presence of multiple aneurysms. A trend towards greater interrater agreement between more experienced raters was noticed.

KEYWORDS:

Aneurysm morphology; Computed tomography angiography; Interrater agreement; Interrater reliability; Neurovascular imaging; Subarachnoid hemorrhage

PMID:
28461281
DOI:
10.1016/j.wneu.2017.04.131
[Indexed for MEDLINE]

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