Reliability of the Diagnosis of Cerebral Vasospasm Using Catheter Cerebral Angiography: A Systematic Review and Inter- and Intraobserver Study

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
FIG 1.
Illustrative case from the portfolio. The degree of vessel narrowing was assessed on the right-sided Index images (A2, B2, C2).
Download figure
Open in new tab
Download powerpoint
FIG 2.
Illustrative cases of maximal agreement and maximal disagreement. Two cases showing A) maximal agreement (17/17 readers rated vasospasm to be “severe” with 50% narrowing threshold), B) maximal disagreement (only 8/17 readers rated vasospasm to be “severe”).
Download figure
Open in new tab
Download powerpoint
FIG 3.
Total number of dichotomized assessments of severe vasospasm and choice for endovascular treatment. Along the x-axis, the graph shows patients primarily ordered according to increasing proportion of severe vasospasm votes. Patients are secondarily ordered within each bracket according to number of votes for endovascular treatment. Circles show patients who received angioplasty in real life. Note that perfect agreement occurs only at the tails of the distribution: cases 1–92 (all no) and 212–221 (all yes).

Table 1:

Characteristics of patients and aneurysms included in the portfolio

Characteristics
No. of cases	221
Age (mean) (range)	51.4, 16–77
Female sex	144 (65.2%)
Aneurysm location
Anterior circulation	183 (82.8%)
Posterior circulation	32 (14.5%)
No aneurysm identified	6 (2.7%)
Aneurysm location
Left	58 (26.2%)
Right	96 (43.4%)
Midline	61 (27.6%)
None found	6 (2.7%)
WFNS grade
I	78 (35.3%)
II	51 (23.1%)
III	16 (7.2%)
IV	33 (14.9%)
V	43 (19.5%)
Modified Fisher grade
1	44 (20.0%)
2	29 (13.1%)
3	65 (29.4%)
4	83 (37.6%)
Treatment details
Surgical clipping	123 (55.7%)
Endovascular treatment	91 (41.2%)
Spontaneous occlusion before treatment	1 (0.5%)
No treatment	6 (2.7%)
Received hypertensive therapy for vasospasm	52 (23.5%)
Received balloon angioplasty for vasospasm	26 (11.8%)

Table 2:

Interrater agreement for the per-patient diagnosis of severe vasospasm on DSA using 50% vessel narrowing threshold (dichotomized)

	κ (95% CI)	Interventional			Junior (n = 9)	Senior (n = 8)
	All Raters (n=17)	Neuroradiologists (n = 10)	Neurosurgeons (n = 4)	Neurologists (n = 3)	Junior (n = 9)	Senior (n = 8)
Supraclinoid ICA	0.568(0.489–0.646)	0.535 (0.457–0.626)	0.549 (0.450–0.642)	0.625 (0.509–0.725)	0.484 (0.400–0.567)	0.652 (0.562–0.735)
M1 segment	0.576 (0.517–0.629)	0.579 (0.515–0.633)	0.514 (0.433–0.593)	0.554(0.461–0.643)	0.512(0.444–0.574)	0.638(0.575–0.693)
A1 segment	0.511 (0.460–0.562)	0.511(0.457-0.563)	0.452 (0.376–0.527)	0.512 (0.444–0.588)	0.512 (0.453–0.571)	0.495 (0.444–0.550)
Basilar	0.533 (0.413–0.646)	0.488 (0.364–0.604)	0.538 (0.364–0.697)	0.551 (0.391–0.699)	0.475 (0.348–0.604)	0.617 (0.493–0.737)
Per-patient assessment^{^a}	0.556 (0.498–0.611)	0.558 (0.494–0.616)	0.495 (0.412–0.583)	0.546 (0.452–0.638)	0.483 (0.414–0.552)	0.629 (0.566–0.686)
Decision to proceed with EVT	0.393 (0.344–0.444)	0.393 (0.336–0.445)	0.414 (0.344–0.490)	0.319 (0.229–0.415)	0.382 (0.328–0.445)	0.410 (0.351–0.469)