PT  - JOURNAL ARTICLE
AU  - S. Jamali
AU  - R. Fahed
AU  - J.-C. Gentric
AU  - L. Letourneau-Guillon
AU  - H. Raoult
AU  - F. Bing
AU  - L. Estrade
AU  - T.N. Nguyen
AU  - É. Tollard
AU  - J.-C. Ferre
AU  - D. Iancu
AU  - O. Naggara
AU  - M. Chagnon
AU  - A. Weill
AU  - D. Roy
AU  - A.J. Fox
AU  - D.F. Kallmes
AU  - J. Raymond
TI  - Inter- and Intrarater Agreement on the Outcome of Endovascular Treatment of Aneurysms Using MRA
AID  - 10.3174/ajnr.A4609
DP  - 2015 Dec 10
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2015/12/10/ajnr.A4609.short
4100  - http://www.ajnr.org/content/early/2015/12/10/ajnr.A4609.full
AB  - BACKGROUND AND PURPOSE: Patients treated with coiling are often followed by MR angiography. Our objective was to assess the inter- and intraobserver agreement in diagnosing aneurysm remnants and recurrences by using multimodality imaging, including TOF MRA.MATERIALS AND METHODS: A portfolio composed of 120 selected images from 56 patients was sent to 15 neuroradiologists from 10 institutions. For each case, raters were asked to classify angiographic results (3 classes) of 2 studies (32 MRA-MRA and 24 DSA-MRA pairs) and to provide a final judgment regarding the presence of a recurrence (no, minor, major). Six raters were asked to independently review the portfolio twice. A second study, restricted to 4 raters having full access to all images, was designed to validate the results of the electronic survey.RESULTS: The proportion of cases judged to have a major recurrence varied between 16.1% and 71.4% (mean, 35.0% ± 12.7%). There was moderate agreement overall (κ = 0.474 ± 0.009), increasing to nearly substantial (κ = 0.581 ± 0.014) when the judgment was dichotomized (presence or absence of a major recurrence). Agreement on cases followed-up by MRA-MRA was similarly substantial (κ = 0.601 ± 0.018). The intrarater agreement varied between fair (κ = 0.257 ± 0.093) and substantial (κ= 0.699 ± 0.084), improving with a dichotomized judgment concerning MRA-MRA comparisons. Agreement was no better when raters had access to all images.CONCLUSIONS: There is an important variability in the assessment of angiographic outcomes of endovascular treatments. Agreement on the presence of a major recurrence when comparing 2 MRA studies or the MRA with the last catheter angiographic study can be substantial.