Anass Benomar1, Behzad Farzin1, David Volders2, Guylaine Gevry1, Justine Zehr3, Robert Fahed4, William Boisseau1, Jean-Christophe Gentric5, Elsa Magro6, Lorena Nico7, Daniel Roy1, Alain Weill1, Charbel Mounayer8, François Guilbert1, Laurent Létourneau-Guillon1, Gregory Jacquin9, Chiraz Chaalala10, Marc Kotowski11, Thanh N Nguyen12, David Kallmes13, Phil White14, Tim E Darsaut15, Jean Raymond16. 1. Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, H2X 0C1, Canada. 2. Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada. 3. Department of Mathematics and Statistics, Université de Montréal, Montreal, QC, Canada. 4. Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada. 5. Service de neuroradiologie interventionnelle, Hôpital de la Cavale Blanche, CHRU de Brest, Brest, France. 6. Service de neurochirurgie, Hôpital de la Cavale Blanche, CHRU de Brest, Brest, France. 7. Service de radiologie, CHU de Caen Normandie, Caen, France. 8. Service de neuroradiologie interventionnelle, Hôpital Dupuytren, CHU Limoges, Limoges, France. 9. Department of Medicine, Division of Neurology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. 10. Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. 11. Service de neurochirurgie, Hôpital de la Providence, Neuchâtel, Switzerland. 12. Department of Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, MA, USA. 13. Department of Radiology, Mayo Clinic, Rochester, MN, USA. 14. Neuroradiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK. 15. Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Edmonton, AB, Canada. 16. Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, H2X 0C1, Canada. jean.raymond@umontreal.ca.
Abstract
PURPOSE: Results of surgical or endovascular treatment of intracranial aneurysms are often assessed using angiography. A reliable method to report results irrespective of treatment modality is needed to enable comparisons. Our goals were to systematically review existing classification systems, and to propose a 3-point classification applicable to both treatments and assess its reliability. METHODS: We conducted two systematic reviews on classification systems of angiographic results after clipping or coiling to select a simple 3-category scale that could apply to both treatments. We then circulated an electronic portfolio of angiograms of clipped (n=30) or coiled (n=30) aneurysms, and asked raters to evaluate the degree of occlusion using this scale. Raters were also asked to choose an appropriate follow-up management for each patient based on the degree of occlusion. Agreement was assessed using Krippendorff's α statistics (αK), and relationship between occlusion grade and clinical management was analyzed using Fisher's exact and Cramer's V tests. RESULTS: The systematic reviews found 70 different grading scales with heterogeneous reliability (kappa values from 0.12 to 1.00). The 60-patient portfolio was independently evaluated by 19 raters of diverse backgrounds (neurosurgery, radiology, and neurology) and experience. There was substantial agreement (αK=0.76, 95%CI, 0.67-0.83) between raters, regardless of background, experience, or treatment used. Intra-rater agreement ranged from moderate to almost perfect. A strong relationship was found between angiographic grades and management decisions (Cramer's V: 0.80±0.12). CONCLUSION: A simple 3-point scale demonstrated sufficient reliability to be used in reporting aneurysm treatments or in evaluating treatment results in comparative randomized trials.
PURPOSE: Results of surgical or endovascular treatment of intracranial aneurysms are often assessed using angiography. A reliable method to report results irrespective of treatment modality is needed to enable comparisons. Our goals were to systematically review existing classification systems, and to propose a 3-point classification applicable to both treatments and assess its reliability. METHODS: We conducted two systematic reviews on classification systems of angiographic results after clipping or coiling to select a simple 3-category scale that could apply to both treatments. We then circulated an electronic portfolio of angiograms of clipped (n=30) or coiled (n=30) aneurysms, and asked raters to evaluate the degree of occlusion using this scale. Raters were also asked to choose an appropriate follow-up management for each patient based on the degree of occlusion. Agreement was assessed using Krippendorff's α statistics (αK), and relationship between occlusion grade and clinical management was analyzed using Fisher's exact and Cramer's V tests. RESULTS: The systematic reviews found 70 different grading scales with heterogeneous reliability (kappa values from 0.12 to 1.00). The 60-patient portfolio was independently evaluated by 19 raters of diverse backgrounds (neurosurgery, radiology, and neurology) and experience. There was substantial agreement (αK=0.76, 95%CI, 0.67-0.83) between raters, regardless of background, experience, or treatment used. Intra-rater agreement ranged from moderate to almost perfect. A strong relationship was found between angiographic grades and management decisions (Cramer's V: 0.80±0.12). CONCLUSION: A simple 3-point scale demonstrated sufficient reliability to be used in reporting aneurysm treatments or in evaluating treatment results in comparative randomized trials.
Entities:
Keywords:
Classification system; Digital subtraction angiography; Inter-rater reliability; Intracranial aneurysms
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