Iancu-Gontard D, Weill A, Guilbert F, Nguyen T, Raymond J, Roy D
Department of Radiology, Interventional Neuroradiology Section, Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, PQ, Canada.
AJNR Am J Neuroradiol. 2007 Mar;28(3):524-7.
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.
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 (kappa) for nominal data and the weighted kappa for ordinal data.
Inter- and intraobserver agreement were higher for assessment of the Spetzler-Martin grade (weighted kappa = 0.70/0.75) and nidus size reduction after endovascular treatment (kappa = 0.74/0.77). Inter- and intraobserver agreement were inferior for findings concerning feeding artery aneurysms (kappa = 0.19/0.36), intranidal aneurysms (kappa = 0.34/0.35), and venous aneurysms (kappa = 0.50/0.67).
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.
脑动静脉畸形（BAVM）的一些血管造影特征与出血风险增加相关。然而，不同观察者对这些特征的解读可能不一致。我们开展了一项研究，以确定BAVM各种血管构筑特征在观察者间和观察者内的一致性。
两位经验丰富的介入神经放射科医生独立回顾了50例连续患者血管内治疗前后的血管造影图像。纳入治疗前的轴向CT和/或MR图像。我们收集了以下数据：斯佩茨勒-马丁分级、受累动脉区域数量、按位置（ Willis环、供血动脉、瘤巢内、静脉）分类的相关动脉瘤，以及血管内治疗后瘤巢缩小情况（<33%、33%-66%和>66%）。对两位观察者的结果进行比较，并在间隔3个月后让其中一位观察者与自己之前的结果进行比较。一致性测量采用名义数据的kappa统计量（kappa）和有序数据的加权kappa。
观察者间和观察者内对斯佩茨勒-马丁分级评估（加权kappa = 0.70/0.75）以及血管内治疗后瘤巢大小缩小情况（kappa = 0.74/0.77）的一致性较高。观察者间和观察者内对供血动脉动脉瘤（kappa = 0.19/0.36）、瘤巢内动脉瘤（kappa = 0.34/0.35）和静脉动脉瘤（kappa = 0.50/0.67）的观察结果一致性较差。
被视为出血危险因素的BAVM血管造影特征，如动脉瘤，在不同观察者的整体血管造影图像上无法可靠检测。相比之下，斯佩茨勒-马丁分级系统和血管内治疗的血管造影结果在观察者间具有较高的一致性。
