Noninvasive Angiographic Results of Clipped or Coiled Intracranial Aneurysms: An Inter- and Intraobserver Reliability Study

Abstract

<h3>BACKGROUND AND PURPOSE:</h3> Noninvasive angiography is commonly used to assess the outcome of surgical or endovascular treatment of intracranial aneurysms in clinical series or randomized trials. We sought to assess whether a standardized 3-grade classification system could be reliably used to compare the CTA and MRA results of both treatments. <h3>MATERIALS AND METHODS:</h3> An electronic portfolio composed of CTAs of 30 clipped and MRAs of 30 coiled aneurysms was independently evaluated by 24 raters of diverse experience and training backgrounds. Twenty raters performed a second evaluation 1 month later. Raters were asked which angiographic grade and management decision (retreatment; close or long-term follow-up) would be most appropriate for each case. Agreement was analyzed using the Krippendorff α (α_K) statistic, and the relationship between angiographic grade and clinical management choice, using the Fisher exact and Cramer V tests. <h3>RESULTS:</h3> Interrater agreement was substantial (α_K = 0.63; 95% CI, 0.55–0.70); results were slightly better for MRA results of coiling (α_K = 0.69; 95% CI, 0.56–0.76) than for CTA results of clipping (α_K = 0.58; 95% CI, 0.44–0.69). Intrarater agreement was substantial to almost perfect. Interrater agreement regarding clinical management was moderate for both clipped (α_K = 0.49; 95% CI, 0.32–0.61) and coiled subgroups (α_K = 0.47; 95% CI, 0.34–0.54). The choice of clinical management was strongly associated with the size of the residuum (mean Cramer V = 0.77 [SD, 0.14]), but complete occlusions (grade 1) were followed more closely after coiling than after clipping (<i>P </i>= .01). <h3>CONCLUSIONS:</h3> A standardized 3-grade scale was found to be a reliable and clinically meaningful tool to compare the results of clipping and coiling of aneurysms using CTA or MRA.