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Interrater Reliability in the Measurement of Flow Characteristics on Color-Coded Quantitative DSA of Brain AVMs
K H Narsinh1, K Mueller2, J Nelson3
1From the Department of Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.).
Background And Purpose:
Hemodynamic features of brain AVMs may portend increased hemorrhage risk. Previous studies have suggested that MTT is shorter in ruptured AVMs as assessed on quantitative color-coded parametric DSA. This study assesses the interrater reliability of MTT measurements obtained using quantitative color-coded DSA.
Materials And Methods:
Thirty-five color-coded parametric DSA images of 34 brain AVMs were analyzed by 4 neuroradiologists with experience in interventional neuroradiology. Hemodynamic features assessed included MTT of the AVM and TTP of the dominant feeding artery and draining vein. Agreement among the 4 raters was assessed using the intraclass correlation coefficient.
Results:
The interrater reliability among the 4 raters was poor (intraclass correlation coefficient = 0.218; 95% CI, 0.062-0.414; P value = .002) as it related to MTT assessment. When the analysis was limited to cases in which the raters selected the same image to analyze and selected the same primary feeding artery and the same primary draining vein, interrater reliability improved to fair (intraclass correlation coefficient = 0.564; 95% CI, 0.367-0.717; P < .001).
Conclusions:
Interrater reliability in deriving color-coded parametric DSA measurements such as MTT is poor so minor differences among raters may result in a large variance in MTT and TTP results, partly due to the sensitivity and 2D nature of the technique. Reliability can be improved by defining a standard projection, feeding artery, and draining vein for analysis.
Insights
Interrater reliability for measuring mean transit time (MTT) in brain arteriovenous malformations (AVMs) using quantitative digital subtraction angiography (DSA) is poor. Standardizing analysis parameters can improve the consistency of these hemodynamic assessments.
Area of Science:
- Neuroradiology
- Vascular Imaging
- Medical Device Technology
Background:
- Hemodynamic features of brain arteriovenous malformations (AVMs) are crucial for assessing hemorrhage risk.
- Previous research suggests shorter mean transit time (MTT) in ruptured AVMs using quantitative color-coded digital subtraction angiography (DSA).
Purpose of the Study:
- To evaluate the interrater reliability of MTT measurements in brain AVMs using quantitative color-coded DSA.
- To determine the consistency of hemodynamic assessments among neuroradiologists.
Main Methods:
- Four neuroradiologists analyzed 35 DSA images from 34 brain AVMs.
- Hemodynamic features, including AVM MTT and time to peak (TTP) of feeding artery and draining vein, were assessed.
- Interrater agreement was quantified using the intraclass correlation coefficient (ICC).
Main Results:
- Overall interrater reliability for MTT assessment was poor (ICC = 0.218).
- When analysis was standardized to specific images, feeding arteries, and draining veins, interrater reliability improved to fair (ICC = 0.564).
Conclusions:
- Interrater reliability for quantitative color-coded DSA measurements like MTT is generally poor.
- Variability in MTT and TTP results can arise from the technique's sensitivity and 2D nature.
- Standardizing projection, feeding artery, and draining vein selection can enhance measurement reliability.
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