RT Journal Article
SR Electronic
T1 Reliability of the Diagnosis of Cerebral Vasospasm Using Catheter Cerebral Angiography: A Systematic Review and Inter- and Intraobserver Study
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 501
OP 507
DO 10.3174/ajnr.A7021
VO 42
IS 3
A1 T.E. Darsaut
A1 C. Derksen
A1 B. Farzin
A1 M.B. Keough
A1 R. Fahed
A1 W. Boisseau
A1 L. Letourneau-Guillon
A1 A.-C. Januel
A1 A. Weill
A1 D. Roy
A1 T.N. Nguyen
A1 S. Finitsis
A1 J.-C. Gentric
A1 D. Volders
A1 A. Carlson
A1 M.M. Chow
A1 C. O’Kelly
A1 J.L. Rempel
A1 R.A. Ashforth
A1 M. Chagnon
A1 J. Zehr
A1 J.M. Findlay
A1 G. Gevry
A1 J. Raymond
YR 2021
UL http://www.ajnr.org/content/42/3/501.abstract
AB BACKGROUND AND PURPOSE: Conventional angiography is the benchmark examination to diagnose cerebral vasospasm, but there is limited evidence regarding its reliability. Our goals were the following: 1) to systematically review the literature on the reliability of the diagnosis of cerebral vasospasm using conventional angiography, and 2) to perform an agreement study among clinicians who perform endovascular treatment.MATERIALS AND METHODS: Articles reporting a classification system on the degree of cerebral vasospasm on conventional angiography were systematically searched, and agreement studies were identified. We assembled a portfolio of 221 cases of patients with subarachnoid hemorrhage and asked 17 raters with different backgrounds (radiology, neurosurgery, or neurology) and experience (junior ≤10 and senior >10 years) to independently evaluate cerebral vasospasm in 7 vessel segments using a 3-point scale and to evaluate, for each case, whether findings would justify endovascular treatment. Nine raters took part in the intraobserver reliability study.RESULTS: The systematic review showed a very heterogeneous literature, with 140 studies using 60 different nomenclatures and 21 different thresholds to define cerebral vasospasm, and 5 interobserver studies reporting a wide range of reliability (κ = 0.14–0.87). In our study, only senior raters reached substantial agreement (κ ≥ 0.6) on vasospasm of the supraclinoid ICA, M1, and basilar segments and only when assessments were dichotomized (presence or absence of ≥50% narrowing). Agreement on whether to proceed with endovascular management of vasospasm was only fair (κ ≤ 0.4).CONCLUSIONS: Research on cerebral vasospasm would benefit from standardization of definitions and thresholds. Dichotomized decisions by experienced readers are required for the reliable angiographic diagnosis of cerebral vasospasm.