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A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis
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Interobserver Agreement on Arteriovenous Malformation Diffuseness Using Digital Subtraction Angiography.

Maria Braileanu1, Wuyang Yang2, Justin M Caplan2

  • 1Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.

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Summary

Physician agreement on arteriovenous malformation (AVM) diffuseness using digital subtraction angiography (DSA) varied from fair to substantial. Developing objective, 3D measures is crucial for consistent clinical application of AVM assessment.

Keywords:
Arteriovenous malformationDiffusenessDigital subtraction angiographyInterobserver agreement

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Arteriovenous malformation (AVM) diffuseness is a known prognostic indicator for treatment outcomes.
  • Assessing AVM diffuseness is critical for effective patient management.

Purpose of the Study:

  • To evaluate interobserver agreement on AVM diffuseness among physicians with diverse specialties and training.
  • To determine the reliability of digital subtraction angiography (DSA) in assessing AVM diffuseness.

Main Methods:

  • A retrospective review of 80 DSA views from 36 AVMs was conducted.
  • Four physicians (2 neurosurgeons, 1 interventional neuroradiologist, 1 neurosurgical resident) assessed AVMs as compact or diffuse in a single-blinded manner.
  • Interobserver agreement was analyzed using kappa (κ) statistics and intraclass correlation coefficients (ICC).

Main Results:

  • Disagreement on AVM diffuseness occurred in 43.8% of DSA views.
  • Interobserver agreement (κ) ranged from fair (0.40) to substantial (0.65) for DSA views and fair (0.36) to moderate (0.57) for AVMs.
  • Intraclass correlation coefficients (ICC) were 0.81 for DSA views and 0.68 for AVMs, indicating moderate to substantial agreement overall.
  • Moderate agreement was observed between attending and resident assessments (κ=0.57) and between neurosurgeon and interventional neuroradiologist assessments (κ=0.55).

Conclusions:

  • Physician agreement on AVM diffuseness based on DSA varies significantly.
  • Current subjective assessments may lead to inconsistencies in clinical application.
  • Development of objective and three-dimensional (3D) measures for AVM diffuseness is recommended to improve diagnostic consistency.