RT Journal Article
SR Electronic
T1 CTA Supplemented by CTP Increases Interrater Reliability and Endovascular Treatment Use in Patients with Aneurysmal SAH
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 284
OP 290
DO 10.3174/ajnr.A8110
VO 45
IS 3
A1 Heitkamp, Christian
A1 Geest, Vincent
A1 Tokareva, Bogdana
A1 Winkelmeier, Laurens
A1 Faizy, Tobias D.
A1 Meyer, Lukas
A1 Kyselyova, Anna A.
A1 Meyer, Hanno S.
A1 Wentz, Rabea
A1 Fiehler, Jens
A1 Bester, Maxim
A1 Thaler, Christian
YR 2024
UL http://www.ajnr.org/content/45/3/284.abstract
AB BACKGROUND AND PURPOSE: Cerebral vasospasm is a common complication of aneurysmal SAH and remains a risk factor for delayed cerebral ischemia and poor outcome. The interrater reliability of CTA in combination with CTP has not been sufficiently studied. We aimed to investigate the reliability of CTA alone and in combination with CTP in the detection of cerebral vasospasm and the decision to initiate endovascular treatment.MATERIALS AND METHODS: This is a retrospective single-center study including patients treated for aneurysmal SAH. Inclusion criteria were a baseline CTA and follow-up imaging including CTP due to suspected vasospasm. Three neuroradiologists were asked to grade 15 intracranial arterial segments in 71 cases using a tripartite scale (no, mild <50%, or severe >50% vasospasm). Raters further evaluated whether endovascular treatment should be indicated. The ratings were performed in 2 stages with a minimum interval of 6 weeks. The first rating included only CTA images, whereas the second rating additionally encompassed CTP images. All raters were blinded to any clinical information of the patients.RESULTS: Interrater reliability for per-segment analysis of vessels was highly variable (κ = 0.16–0.61). We observed a tendency toward higher interrater reliability in proximal vessel segments, except for the ICA. CTP did not improve the reliability for the per-segment analysis. When focusing on senior raters, the addition of CTP images resulted in higher interrater reliability for severe vasospasm (κ = 0.28; 95% CI, 0.10–0.46 versus κ = 0.46; 95% CI, 0.26–0.66) and subsequently higher concordance (κ = 0.23; 95% CI, −0.01–0.46 versus κ = 0.73; 95% CI, 0.55–0.91) for the decision of whether endovascular treatment was indicated.CONCLUSIONS: CTA alone offers only low interrater reliability in the graduation of cerebral vasospasm. However, using CTA in combination with CTP might help, especially senior neuroradiologists, to increase the interrater reliability to identify severe vasospasm following aneurysmal SAH and to increase the reliability regarding endovascular treatment decisions.ACAanterior cerebral arteryaSAHaneurysmal SAHDCIdelayed cerebral ischemiaIQRinterquartile rangeTCDtranscranial Doppler sonography