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

Publication

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

Journal Paper/Review - Apr 28, 2017

Maldaner Nicolai, Regli Luca, Bozinov Oliver, Neidert Marian Christoph, Esposito Giuseppe, Serra Carlo, Daniel Roy Thomas, Maduri Rodolfo, Marbacher Serge, Dalonzo Donato, Zumofen Daniel W, Croci Davide, Bijlenga Philippe, Stienen Martin N, Burkhardt Jan-Karl

Citation

Maldaner N, Regli L, Bozinov O, Neidert M, Esposito G, Serra C, Daniel R, Maduri R, Marbacher S, Dalonzo D, Zumofen D, Croci D, Bijlenga P, Stienen M, Burkhardt J. Interrater Agreement in the Radiologic Characterization of Ruptured Intracranial Aneurysms Based on Computed Tomography Angiography. World Neurosurg 2017; 103:876-882.e1.

Type

Journal Paper/Review (English)

Journal

World Neurosurg 2017; 103

Publication Date

Apr 28, 2017

Issn Electronic

1878-8769

Pages

876-882.e1

Brief description/objective

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.