title: Inter- and Intrarater Agreement on the Outcome of Endovascular Treatment of Aneurysms Using MRA.
abstract: Patients treated with coiling are often followed by MR angiography. Our objective was to assess the inter- and intraobserver agreement in diagnosing aneurysm remnants and recurrences by using multimodality imaging, including TOF MRA.
  
  
  
  A portfolio composed of 120 selected images from 56 patients was sent to 15 neuroradiologists from 10 institutions. For each case, raters were asked to classify angiographic results (3 classes) of 2 studies (32 MRA-MRA and 24 DSA-MRA pairs) and to provide a final judgment regarding the presence of a recurrence (no, minor, major). Six raters were asked to independently review the portfolio twice. A second study, restricted to 4 raters having full access to all images, was designed to validate the results of the electronic survey.
  
  
  
  The proportion of cases judged to have a major recurrence varied between 16.1% and 71.4% (mean, 35.0% ± 12.7%). There was moderate agreement overall (κ = 0.474 ± 0.009), increasing to nearly substantial (κ = 0.581 ± 0.014) when the judgment was dichotomized (presence or absence of a major recurrence). Agreement on cases followed-up by MRA-MRA was similarly substantial (κ = 0.601 ± 0.018). The intrarater agreement varied between fair (κ = 0.257 ± 0.093) and substantial (κ= 0.699 ± 0.084), improving with a dichotomized judgment concerning MRA-MRA comparisons. Agreement was no better when raters had access to all images.
  
  
  
  There is an important variability in the assessment of angiographic outcomes of endovascular treatments. Agreement on the presence of a major recurrence when comparing 2 MRA studies or the MRA with the last catheter angiographic study can be substantial.
authors.affiliation: From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada.
authors.forename: S
authors.identifier: 0000-0002-4279-7527
authors.initials: S
authors.lastname: Jamali
authors.affiliation: From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada.
authors.forename: R
authors.identifier: 0000-0002-1887-5097
authors.initials: R
authors.lastname: Fahed
authors.affiliation: From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada Groupe d'étude de la Thrombose en Bretagne Occidentale (J.-C.G.), Brest, France.
authors.forename: J-C
authors.identifier: 0000-0002-1655-1371
authors.initials: JC
authors.lastname: Gentric
authors.affiliation: From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada.
authors.forename: L
authors.identifier: 0000-0002-6325-7538
authors.initials: L
authors.lastname: Letourneau-Guillon
authors.affiliation: Service de radiologie et imagerie médicale (H.R., J.-C.F.), Centre Hospitalier Universitaire de Rennes, Rennes, France.
authors.forename: H
authors.identifier: 0000-0002-0458-3309
authors.initials: H
authors.lastname: Raoult
authors.affiliation: Service imagerie médicale et interventionnelle (F.B.), Centre Hospitalier Annecy Genevois, St-Julien en Genevois, France.
authors.forename: F
authors.identifier: 0000-0003-2762-6559
authors.initials: F
authors.lastname: Bing
authors.affiliation: Service Imagerie, Médecine nucléaire et Explorations fonctionnelles (L.E.), Centre Hospitalier Régional Universitaire de Lille, Lille, France.
authors.forename: L
authors.identifier: 0000-0002-9010-7447
authors.initials: L
authors.lastname: Estrade
authors.affiliation: Departments of Neurology, Neurosurgery, and Radiology (T.N.N.), Boston Medical Center, Boston, Massachusetts.
authors.forename: T N
authors.identifier: 0000-0002-5919-6170
authors.initials: TN
authors.lastname: Nguyen
authors.affiliation: Service d'Imagerie Médicale (E.T.), Centre Hospitalier Universitaire Hôpitaux de Rouen, Charles Nicolle, Rouen, France.
authors.forename: É
authors.identifier: 0000-0002-2217-6184
authors.initials: É
authors.lastname: Tollard
authors.affiliation: Service de radiologie et imagerie médicale (H.R., J.-C.F.), Centre Hospitalier Universitaire de Rennes, Rennes, France.
authors.forename: J-C
authors.identifier: 0000-0003-3911-1800
authors.initials: JC
authors.lastname: Ferre
authors.affiliation: Service of Diagnostic Imaging (D.I.), The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada;.
authors.forename: D
authors.identifier: 0000-0003-2041-9178
authors.initials: D
authors.lastname: Iancu
authors.affiliation: Service d'Imagerie Morphologique et Fonctionnelle (O.N.), Centre Hospitalier Sainte Anne, Paris, France.
authors.forename: O
authors.identifier: 0000-0002-9544-379X
authors.initials: O
authors.lastname: Naggara
authors.affiliation: Department of Mathematics and Statistics (M.C.), University of Montreal, Montreal, Quebec, Canada.
authors.forename: M
authors.identifier: 0000-0002-2291-9566
authors.initials: M
authors.lastname: Chagnon
authors.affiliation: From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Weill
authors.affiliation: From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Roy
authors.affiliation: Department of Medical Imaging (A.J.F.), University of Toronto, Toronto, Ontario, Canada.
authors.forename: A J
authors.identifier: 0000-0001-5465-5801
authors.initials: AJ
authors.lastname: Fox
authors.affiliation: Department of Neurointerventional Radiology (D.F.K.), Mayo Clinic, Rochester, Minnesota.
authors.forename: D F
authors.identifier: 0000-0002-8495-0040
authors.initials: DF
authors.lastname: Kallmes
authors.affiliation: From the Department of Radiology (S.J., R.F., J.-C.G., L.L.-G., A.W., D.R., J.R.), Centre Hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montreal, Quebec, Canada jean.raymond@umontreal.ca.
authors.forename: J
authors.initials: J
authors.lastname: Raymond
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D059906:Neuroimaging / Q000379:methods*; D015203:Reproducibility of Results; D016896:Treatment Outcome