• World Neurosurg · Jul 2017

    Interrater Agreement in the Radiological Characterization of Ruptured Intracranial Aneurysms Based on CT-angiography.

    • Nicolai Maldaner, Martin N Stienen, Philippe Bijlenga, Davide Croci, Daniel W Zumofen, Donato Dalonzo, Serge Marbacher, Rodolfo Maduri, Roy Thomas Daniel, Carlo Serra, Giuseppe Esposito, Marian Christoph Neidert, Oliver Bozinov, Luca Regli, and Jan-Karl Burkhardt.
    • Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland. Electronic address: nicolai.maldaner@usz.ch.
    • World Neurosurg. 2017 Jul 1; 103: 876-882.e1.

    ObjectiveTo 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.MethodsOne 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.ResultsThere 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.ConclusionsInterrater 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.Copyright © 2017 Elsevier Inc. All rights reserved.

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