Interrater Agreement in the Radiologic Characterization of Ruptured Intracranial Aneurysms Based on Computed
Nicolai Maldaner1, Martin N Stienen2, Philippe Bijlenga3
1Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
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.
Related Concept Videos
Computed Tomography
The technique was invented in the 1970s and is based on the principle that as X-rays pass through the body, they are absorbed or reflected at different levels. In the technique, a patient lies on a motorized platform while a computerized axial tomography (CAT) scanner rotates...
Imaging Studies III: Computed Tomography
Aneurysm II: Clinical Manifestations and Diagnostic Studies
Aneurysm III: Interprofessional Care


