From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.G., A.M.F., J.F., J.-H.B.), Center for Radiology and Endoscopy
Department of Medical Psychology (L.K.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
AJNR Am J Neuroradiol. 2018 May;39(5):869-874. doi: 10.3174/ajnr.A5581. Epub 2018 Mar 22.
Angiographic occlusion and retreatment of coiled aneurysms are commonly used as surrogate end points in clinical trials. We aimed to evaluate the influence of aneurysm, patient, and rater characteristics on the confidence of visual evaluation of aneurysm coiling and retreatment decisions.
Twenty-six participants of the Advanced Course in Endovascular Interventional Neuroradiology of the European Society of Neuroradiology were asked to evaluate digital subtraction angiography examinations of patients who had undergone endovascular coiling, by determining the grade of aneurysm occlusion, the change between immediate postprocedural and follow-up angiograms, their level of confidence, the technical difficulty of retreatment, and the best therapeutic approach. The experience, knowledge, and skills of each participant were assessed. The influence of rater and case characteristics on indicated confidence in diagnostic ratings and retreatment recommendations was analyzed.
Interrater reliability was moderate regarding the assessment of aneurysm occlusion grade (intraclass correlation coefficient = 0.581) and substantial regarding change (intraclass correlation coefficient = 0.776). Overall confidence in the diagnostic rating was high (median, "very certain"). Confidence was statistically significantly higher in cases that were generally rated as "worse." The odds of recommending retreatment were significantly higher in cases that were generally rated with higher mean confidence.
Although overall confidence in the diagnostic rating was high, our study confirms the suboptimal interrater reliability of visual assessment of aneurysm occlusion as well as retreatment recommendations, rendering both questionable as primary outcome measures. Besides recurrence status, recommendation of retreatment is significantly influenced by patient age, aneurysm neck width, and characteristics of the therapist.
在临床试验中，血管造影闭塞和再治疗 coil 后的动脉瘤通常被用作替代终点。我们旨在评估动脉瘤、患者和评估者特征对视觉评估 coil 后动脉瘤和再治疗决策的信心的影响。
26 名欧洲神经放射学会血管内介入神经放射学高级课程的参与者被要求通过确定动脉瘤闭塞程度、即刻术后和随访血管造影之间的变化、他们的信心水平、再治疗的技术难度以及最佳治疗方法来评估接受血管内 coil 治疗的患者的数字减影血管造影检查。评估了每个参与者的经验、知识和技能。分析了评估者和病例特征对诊断评分和再治疗建议的指示信心的影响。
在评估动脉瘤闭塞程度方面，评估者之间的可靠性为中度（组内相关系数=0.581），在评估变化方面为实质性（组内相关系数=0.776）。总体而言，对诊断评分的信心很高（中位数为“非常确定”）。在普遍被评为“更差”的病例中，信心有统计学意义地更高。在普遍被评为具有更高平均信心的病例中，推荐再治疗的可能性明显更高。
尽管对诊断评分的总体信心很高，但我们的研究证实了视觉评估动脉瘤闭塞和再治疗建议的可靠性不理想，这使得两者都成为有问题的主要结局指标。除了复发情况外，推荐再治疗还受到患者年龄、动脉瘤颈部宽度和治疗师特征的显著影响。
