Elmokadem Ali H, Elged Basma Abdelmonaem, Abdel Razek Ahmed, El-Serougy Lamiaa Galal, Kasem Mohamed Ali, El-Adalany Mohamed Ali
Department of Radiology, Mansoura University, Mansoura 35516, Egypt.
Department of Neurosurgery, Mansoura University, Mansoura 35516, Egypt.
World J Radiol. 2023 Jun 28;15(6):201-215. doi: 10.4329/wjr.v15.i6.201.
Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications. It is critical to make a rapid radiological evaluation of ruptured intracranial aneurysms (RIAs) to determine the appropriate surgical treatment.
To assess the reliability of computed tomography angiography (CTA) in assessing different features of ruptured intracranial aneurysm and its impact on patient management.
The final cohort of this study consisted of 146 patients with RIAs (75 male and 71 female) who underwent cerebral CTA. Their age ranged from 25 to 80, and the mean age ± SD was 57 ± 8.95 years. Two readers were asked to assess different features related to the aneurysm and perianeurysmal environment. Inter-observer agreement was measured using kappa statistics. Imaging data extracted from non-contrast computed tomography and CTA were considered to categorize the study population into two groups according to the recommended therapeutic approach.
The inter-observer agreement of both reviewers was excellent for the detection of aneurysms (K = 0.95, = 0.001), aneurysm location (K = 0.98, = 0.001), and (K = 0.98, = 0.001), morphology (K = 0.92, = 0.001) and margins (K = 0.95, = 0.001). There was an excellent interobserver agreement for the measurement of aneurysm size (K = 0.89, = 0.001), neck (K = 0.85, = 0.001), and dome-to-neck ratio (K = 0.98, = 0.001). There was an excellent inter-observer agreement for the detection of other aneurysm-related features such as thrombosis (K = 0.82, = 0.001), calcification (K = 1.0, = 0.001), bony landmark (K = 0.89, = 0.001) and branch incorporation (K = 0.91, = 0.001) as well as perianeurysmal findings including vasospasm (K = 0.91, = 0.001), perianeurysmal cyst (K = 1.0, = 0.001) and associated vascular lesions (K = 0.83, = 0.001). Based on imaging features, 87 patients were recommended to have endovascular treatment, while surgery was recommended in 59 patients. 71.2% of the study population underwent the recommended therapy.
CTA is a reproducible promising diagnostic imaging modality for detecting and characterizing cerebral aneurysms.
动脉瘤性蛛网膜下腔出血是一种可导致高死亡率和许多严重并发症的急症。对破裂颅内动脉瘤（RIAs）进行快速影像学评估以确定合适的手术治疗至关重要。
评估计算机断层血管造影（CTA）在评估破裂颅内动脉瘤不同特征及其对患者管理影响方面的可靠性。
本研究的最终队列包括146例接受脑部CTA检查的RIAs患者（75例男性和71例女性）。他们的年龄在25至80岁之间，平均年龄±标准差为57±8.95岁。两名阅片者被要求评估与动脉瘤和瘤周环境相关的不同特征。观察者间一致性采用kappa统计量进行测量。从非增强计算机断层扫描和CTA中提取的影像数据被用于根据推荐的治疗方法将研究人群分为两组。
两位阅片者在动脉瘤检测（K = 0.95，P = 0.001）、动脉瘤位置（K = 0.98，P = 0.001）、（此处原文可能有误，推测为瘤颈相关指标，假设为瘤颈宽度，K = 0.98，P = 0.001）、形态（K = 0.92，P = 0.001）和边缘（K = 0.95，P = 0.001）方面的观察者间一致性极佳。在动脉瘤大小测量（K = 0.89，P = 0.001）、瘤颈（K = 0.85，P = 0.001）和瘤顶与瘤颈比值（K = 0.98，P = 0.001）方面，观察者间一致性也极佳。在检测其他与动脉瘤相关的特征如血栓形成（K = 0.82，P = 0.001）、钙化（K = 1.0，P = 0.001）、骨性标志（K = 0.89，P = 0.001）和分支累及（K = 0.91，P = 0.001）以及瘤周发现包括血管痉挛（K = 0.91，P = 0.001）、瘤周囊肿（K = 1.0，P = 0.001）和相关血管病变（K =
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