gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Interrater Agreement in the radiological characterization of ruptured intracranial aneurysms based on CT-angiography

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  • Nicolai Maldaner - Universitätsspital Zürich, Klinik für Neurochirurgie, Zürich, Switzerland
  • Oliver Bozinov - Zürich, Switzerland
  • Roy Thomas Daniel - Lausanne, Switzerland
  • Philippe Bijlenga - Geneva, Switzerland
  • Daniel Zumofen - Basel, Switzerland
  • Martin N. Stienen - Zürich, Switzerland
  • Luca Regli - Zürich, Switzerland
  • Jan-Karl Burkhardt - Zürich, Switzerland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.11.06

doi: 10.3205/17dgnc433, urn:nbn:de:0183-17dgnc4339

Published: June 9, 2017

© 2017 Maldaner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Radiological assessment of ruptured intracranial aneurysms is subject to rater dependent differences. The objective of this study was to determine interrater agreement in the initial radiological characterization of ruptured intracranial aneurysms based on CTA with special emphasis on the rater’s level of experience.

Methods: Out of five high volume neurovascular tertiary centers, one junior and senior rater, evaluated anonymized CTA images of 30 consecutive aneurysmal SAH patients from one selected institution. Each rater described location, side and morphology, the presence of multiple aneurysms as well as maximum diameter, dome and neck diameter of the ruptured intracranial aneurysm in a standardized manner. Interrater variability was analyzed using intraclass correlation and Fleiss´kappa analysis.

Results: There was a substantial to almost perfect agreement for location ( k = 0,76, 95% confidence interval (CI) 0,74 - 0,79), side (k = 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 ruptured intracranial aneurysm. In contrast only poor to moderate agreement was observed for aneurysms neck diameter (ICC = 0,39, CI 0,28 – 0,58), presence of multiple aneurysms (k = 0,35, CI 0,30 – 0,40) and aneurysm morphology (blister k=0,11, CI -0,050 - 0,072; fusiform k=0,54, CI 0,479 - 0,601; multilobular, k=0,39 CI 0,330 - 0,451). We found a generally higher interrater agreement in the senior rater group (median of 12 years of experience) than in the junior rater group (median of 3,5 years of experience).

Conclusion: 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 higher interrater agreement between more experienced raters was noticed.