title: Carotid and vertebral injury study (CAVIS) technique for characterization of blunt traumatic aneurysms with reliability assessment.
abstract: Traumatic aneurysms occur in up to 20% of blunt traumatic extracranial carotid artery injuries. Currently there is no standardized method for characterization of traumatic aneurysms. For the carotid and vertebral injury study (CAVIS), a prospective study of traumatic cerebrovascular injury, we established a method for aneurysm characterization and tested its reliability. Saccular aneurysm size was defined as the greatest linear distance between the expected location of the normal artery wall and the outer edge of the aneurysm lumen ("depth"). Fusiform aneurysm size was defined as the "depth" and longitudinal distance ("length") paralleling the normal artery. The size of the aneurysm relative to the normal artery was also assessed. Reliability measurements were made using four raters who independently reviewed 15 computed tomographic angiograms (CTAs) and 13 digital subtraction angiograms (DSAs) demonstrating a traumatic aneurysm of the internal carotid artery. Raters categorized the aneurysms as either "saccular" or "fusiform" and made measurements. Five scans of each imaging modality were repeated to evaluate intra-rater reliability. Fleiss's free-marginal multi-rater kappa (κ), Cohen's kappa (κ), and interclass correlation coefficient (ICC) determined inter- and intra-rater reliability. Inter-rater agreement as to the aneurysm "shape" was almost perfect for CTA (κ = 0.82) and DSA (κ = 0.897). Agreements on aneurysm "depth," "length," "aneurysm plus parent artery," and "parent artery" for CTA and DSA were excellent (ICC > 0.75). Intra-rater agreement as to aneurysm "shape" was substantial to almost perfect (κ > 0.60). The CAVIS method of traumatic aneurysm characterization has remarkable inter- and intra-rater reliability and will facilitate further studies of the natural history and management of extracranial cerebrovascular traumatic aneurysms.
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, USA cgriessenauer@uabmc.edu.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Griessenauer
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Foreman
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, USA.
authors.forename: Mohammadali M
authors.initials: MM
authors.lastname: Shoja
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, USA.
authors.forename: Kimberly P
authors.initials: KP
authors.lastname: Kicielinski
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Deveikis
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, USA.
authors.forename: Beverly C
authors.initials: BC
authors.lastname: Walters
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Alabama at Birmingham, USA.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Harrigan
mesh_terms: D017541:Aneurysm, False / Q000145:classification / Q000000981:diagnostic imaging / Q000628:therapy; D015901:Angiography, Digital Subtraction; D000070642:Brain Injuries, Traumatic / Q000145:classification* / Q000000981:diagnostic imaging* / Q000628:therapy; D020212:Carotid Artery Injuries / Q000145:classification* / Q000000981:diagnostic imaging* / Q000628:therapy; D002533:Cerebral Angiography; D006801:Humans; D002532:Intracranial Aneurysm / Q000145:classification* / Q000000981:diagnostic imaging* / Q000628:therapy; D000069471:Neurosurgeons; D015588:Observer Variation; D011446:Prospective Studies; D012015:Reference Standards; D015203:Reproducibility of Results; D013124:Spinal Injuries / Q000000981:diagnostic imaging* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000145:classification* / Q000000981:diagnostic imaging* / Q000628:therapy
keywords: Carotid artery; blunt trauma; dissecting aneurysm; pseudoaneurysm; traumatic aneurysm; traumatic cerebrovascular injury