Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, H2X 0C1, Canada.
Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.
Neuroradiology. 2021 Sep;63(9):1511-1519. doi: 10.1007/s00234-021-02676-0. Epub 2021 Feb 24.
Results of surgical or endovascular treatment of intracranial aneurysms are often assessed using angiography. A reliable method to report results irrespective of treatment modality is needed to enable comparisons. Our goals were to systematically review existing classification systems, and to propose a 3-point classification applicable to both treatments and assess its reliability.
We conducted two systematic reviews on classification systems of angiographic results after clipping or coiling to select a simple 3-category scale that could apply to both treatments. We then circulated an electronic portfolio of angiograms of clipped (n=30) or coiled (n=30) aneurysms, and asked raters to evaluate the degree of occlusion using this scale. Raters were also asked to choose an appropriate follow-up management for each patient based on the degree of occlusion. Agreement was assessed using Krippendorff's α statistics (α), and relationship between occlusion grade and clinical management was analyzed using Fisher's exact and Cramer's V tests.
The systematic reviews found 70 different grading scales with heterogeneous reliability (kappa values from 0.12 to 1.00). The 60-patient portfolio was independently evaluated by 19 raters of diverse backgrounds (neurosurgery, radiology, and neurology) and experience. There was substantial agreement (α=0.76, 95%CI, 0.67-0.83) between raters, regardless of background, experience, or treatment used. Intra-rater agreement ranged from moderate to almost perfect. A strong relationship was found between angiographic grades and management decisions (Cramer's V: 0.80±0.12).
A simple 3-point scale demonstrated sufficient reliability to be used in reporting aneurysm treatments or in evaluating treatment results in comparative randomized trials.
颅内动脉瘤的手术或血管内治疗的结果通常通过血管造影进行评估。需要一种可靠的方法来报告结果，而不考虑治疗方式，以便能够进行比较。我们的目标是系统地回顾现有的分类系统，并提出一种适用于两种治疗方法的 3 分分类法，并评估其可靠性。
我们对夹闭或线圈治疗后血管造影结果的分类系统进行了两次系统评价，以选择一种简单的 3 分类量表，适用于两种治疗方法。然后，我们制作了一个夹闭（n=30）或线圈（n=30）动脉瘤的血管造影电子档案，并要求评分者使用该量表评估闭塞程度。评分者还被要求根据闭塞程度为每个患者选择适当的随访管理。使用 Krippendorff 的α统计量（α）评估一致性，使用 Fisher 精确检验和 Cramer's V 检验分析闭塞程度与临床管理之间的关系。
系统评价发现了 70 种不同的分级量表，可靠性差异很大（kappa 值从 0.12 到 1.00）。由 19 名具有不同背景（神经外科、放射科和神经科）和经验的评分者对 60 例患者的档案进行了独立评估。评分者之间存在高度一致（α=0.76，95%置信区间，0.67-0.83），无论背景、经验或使用的治疗方法如何。组内评分者之间的一致性从中度到几乎完美不等。血管造影分级与管理决策之间存在很强的关系（Cramer's V：0.80±0.12）。
一种简单的 3 分量表具有足够的可靠性，可用于报告动脉瘤治疗或在比较随机试验中评估治疗结果。
