Interrater Agreement in the Radiologic Characterization of Ruptured Intracranial Aneurysms Based on Computed Tomography Angiography

World Neurosurg. 2017 Jul;103:876-882.e1. doi: 10.1016/j.wneu.2017.04.131. Epub 2017 Apr 28.


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.

Keywords: Aneurysm morphology; Computed tomography angiography; Interrater agreement; Interrater reliability; Neurovascular imaging; Subarachnoid hemorrhage.

MeSH terms

  • Aneurysm, Ruptured / complications
  • Aneurysm, Ruptured / diagnostic imaging*
  • Carotid Artery, Internal / diagnostic imaging
  • Cerebral Angiography*
  • Computed Tomography Angiography*
  • Female
  • Humans
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / diagnostic imaging*
  • Male
  • Middle Aged
  • Middle Cerebral Artery / diagnostic imaging
  • Observer Variation
  • Reproducibility of Results
  • Rupture, Spontaneous
  • Subarachnoid Hemorrhage / diagnostic imaging*
  • Subarachnoid Hemorrhage / etiology