TY - JOUR T1 - Noninvasive Angiographic Results of Clipped or Coiled Intracranial Aneurysms: An Inter- and Intraobserver Reliability Study JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. DO - 10.3174/ajnr.A7236 AU - A. Benomar AU - B. Farzin AU - G. Gevry AU - W. Boisseau AU - D. Roy AU - A. Weill AU - D. Iancu AU - F. Guilbert AU - L. Létourneau-Guillon AU - G. Jacquin AU - C. Chaalala AU - M.W. Bojanowski AU - M. Labidi AU - R. Fahed AU - D. Volders AU - T.N. Nguyen AU - J.-C. Gentric AU - E. Magro AU - G. Boulouis AU - G. Forestier AU - J.-F. Hak AU - J.S. Ghostine AU - Z. Kaderali AU - J.J. Shankar AU - M. Kotowski AU - T.E. Darsaut AU - J. Raymond Y1 - 2021/07/29 UR - http://www.ajnr.org/content/early/2021/07/29/ajnr.A7236.abstract N2 - BACKGROUND AND PURPOSE: 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.MATERIALS AND METHODS: 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 (αK) statistic, and the relationship between angiographic grade and clinical management choice, using the Fisher exact and Cramer V tests.RESULTS: Interrater agreement was substantial (αK = 0.63; 95% CI, 0.55–0.70); results were slightly better for MRA results of coiling (αK = 0.69; 95% CI, 0.56–0.76) than for CTA results of clipping (αK = 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 (αK = 0.49; 95% CI, 0.32–0.61) and coiled subgroups (αK = 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 (P = .01).CONCLUSIONS: 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.αKKrippendorff α ER -