Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Jun 28, 2023; 15(6): 201-215
Published online Jun 28, 2023. doi: 10.4329/wjr.v15.i6.201
Interobserver reliability of computed tomography angiography in the assessment of ruptured intracranial aneurysm and impact on patient management
Ali H Elmokadem, Basma Abdelmonaem Elged, Ahmed Abdel Razek, Lamiaa Galal El-Serougy, Mohamed Ali Kasem, Mohamed Ali EL-Adalany
Ali H Elmokadem, Basma Abdelmonaem Elged, Ahmed Abdel Razek, Lamiaa Galal El-Serougy, Mohamed Ali EL-Adalany, Department of Radiology, Mansoura University, Mansoura 35516, Egypt
Mohamed Ali Kasem, Department of Neurosurgery, Mansoura University, Mansoura 35516, Egypt
Author contributions: Abdel Razek A and El-Serougy LG proposed the study concept and design; Elged BA searched Database; Kasem MA performed surgical procedures; Elmokadem AH performed DSA; Elged BA, EL-Adalany MA, and El-Serougy LG contributed to analysis and interpretation of data; Elged BA and Elmokadem AH contributed to drafting of the manuscript; Elmokadem AH and Abdel Razek A contributed to Revision of the manuscript; EL-Adalany MA and El-Serougy LG supported technical, or material.
Institutional review board statement: The study was approved by Mansoura university institutional review board (IRB).
Informed consent statement: Patients were not required to give a written consent for the study as the analysis used anonymous data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ali H Elmokadem, MD, PhD, Associate Professor, Department of Radiology, Mansoura University, Elgomhoria St, Mansoura 35516, Egypt. mokademr83@gmail.com
Received: December 23, 2022
Peer-review started: December 23, 2022
First decision: March 28, 2023
Revised: April 17, 2023
Accepted: May 31, 2023
Article in press: May 31, 2023
Published online: June 28, 2023
Processing time: 186 Days and 10.5 Hours
Abstract
BACKGROUND

Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications. It is critical to make a rapid radiological evaluation of ruptured intracranial aneurysms (RIAs) to determine the appropriate surgical treatment.

AIM

To assess the reliability of computed tomography angiography (CTA) in assessing different features of ruptured intracranial aneurysm and its impact on patient management.

METHODS

The final cohort of this study consisted of 146 patients with RIAs (75 male and 71 female) who underwent cerebral CTA. Their age ranged from 25 to 80, and the mean age ± SD was 57 ± 8.95 years. Two readers were asked to assess different features related to the aneurysm and perianeurysmal environment. Inter-observer agreement was measured using kappa statistics. Imaging data extracted from non-contrast computed tomography and CTA were considered to categorize the study population into two groups according to the recommended therapeutic approach.

RESULTS

The inter-observer agreement of both reviewers was excellent for the detection of aneurysms (K = 0.95, P = 0.001), aneurysm location (K = 0.98, P = 0.001), and (K = 0.98, P = 0.001), morphology (K = 0.92, P = 0.001) and margins (K = 0.95, P = 0.001). There was an excellent interobserver agreement for the measurement of aneurysm size (K = 0.89, P = 0.001), neck (K = 0.85, P = 0.001), and dome-to-neck ratio (K = 0.98, P = 0.001). There was an excellent inter-observer agreement for the detection of other aneurysm-related features such as thrombosis (K = 0.82, P = 0.001), calcification (K = 1.0, P = 0.001), bony landmark (K = 0.89, P = 0.001) and branch incorporation (K = 0.91, P = 0.001) as well as perianeurysmal findings including vasospasm (K = 0.91, P = 0.001), perianeurysmal cyst (K = 1.0, P = 0.001) and associated vascular lesions (K = 0.83, P = 0.001). Based on imaging features, 87 patients were recommended to have endovascular treatment, while surgery was recommended in 59 patients. 71.2% of the study population underwent the recommended therapy.

CONCLUSION

CTA is a reproducible promising diagnostic imaging modality for detecting and characterizing cerebral aneurysms.

Keywords: Computed tomography angiography; Intracranial aneurysm; Subarachnoid hemorrhage; Intracranial hemorrhage; Observer variation

Core Tip: This study evaluated the interobserver reliability of computed tomography angiography (CTA) in the assessment of ruptured intracranial aneurysm features among 146 patients. Our results showed good to an excellent inter-observer agreement in imaging features related to the aneurysm, aneurysm characters, measurements, and perianeurysmal information. Imaging data extracted from non-contrast computed tomography and CTA guided the multidisciplinary neurovascular team to better treatment approach selection.