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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 28:524-527, March 2007
© 2007 American Society of Neuroradiology

INTERVENTIONAL

Inter- and Intraobserver Variability in the Assessment of Brain Arteriovenous Malformation Angioarchitecture and Endovascular Treatment Results

D. Iancu-Gontard^a, A. Weill^a, F. Guilbert^a, T. Nguyen^a, J. Raymond^a and D. Roy^a

^a From the Department of Radiology, Interventional Neuroradiology Section, Centre Hospitalier de l’Université de Montréal, Notre-Dame Hospital, Montreal, PQ, Canada

Please address correspondence to Daniel Roy, MD, CHUM–Notre-Dame Hospital, Interventional Neuroradiology, 1560 Sherbrooke East, Ste M8203, Montreal, PQ, Canada H2L 4M1; e-mail: daniel.roy.chum{at}ssss.gouv.qc.ca

BACKGROUND AND PURPOSE: Several angiographic features of brain arteriovenous malformations (BAVMs) have been associated with an increased risk of hemorrhage. However, interpretation of these features may not be consistent between observers. We conducted a study to determine inter- and intraobserver agreement of various angioarchitectural characteristics of BAVM.

MATERIALS AND METHODS: Two experienced interventional neuroradiologists independently reviewed pre- and post-endovascular treatment angiograms from 50 consecutive patients. Axial CT and/or MR images before treatment were included. We collected the following data: Spetzler-Martin grades, number of involved arterial territories, associated aneurysms by location (circle of Willis, feeding artery, intranidal, and venous), and nidus reduction after endovascular treatment (<33%, 33%–66%, and >66%). The reviewers were compared with each other, and 1 was compared with himself after a 3-month interval. Measures of agreement were performed by using the kappa statistic () for nominal data and the weighted for ordinal data.

RESULTS: Inter- and intraobserver agreement were higher for assessment of the Spetzler-Martin grade (weighted = 0.70/0.75) and nidus size reduction after endovascular treatment ( = 0.74/0.77). Inter- and intraobserver agreement were inferior for findings concerning feeding artery aneurysms ( = 0.19/0.36), intranidal aneurysms ( = 0.34/0.35), and venous aneurysms ( = 0.50/0.67).

CONCLUSION: Angiographic characteristics of BAVMs considered as risk factors for hemorrhage, such as aneurysms, are not reliably detected on global angiograms between different observers. In contrast, the Spetzler-Martin grading system and angiographic results of endovascular treatment can be used with high observer agreement.