Abstract
Hemodynamic features of brain AVMs may portend increased hemorrhage risk. Previous studies have suggested that MTT is shorter in ruptured AVMs as assessed on quantitative color-coded parametric DSA. This study assesses the interrater reliability of MTT measurements obtained using quantitative color-coded DSA. Thirty-five color-coded parametric DSA images of 34 brain AVMs were analyzed by 4 neuroradiologists with experience in interventional neuroradiology. Hemodynamic features assessed included MTT of the AVM and TTP of the dominant feeding artery and draining vein. Agreement among the 4 raters was assessed using the intraclass correlation coefficient. The interrater reliability among the 4 raters was poor (intraclass correlation coefficient = 0.218; 95% CI, 0.062-0.414; P value = .002) as it related to MTT assessment. When the analysis was limited to cases in which the raters selected the same image to analyze and selected the same primary feeding artery and the same primary draining vein, interrater reliability improved to fair (intraclass correlation coefficient = 0.564; 95% CI, 0.367-0.717; P < .001). Interrater reliability in deriving color-coded parametric DSA measurements such as MTT is poor so minor differences among raters may result in a large variance in MTT and TTP results, partly due to the sensitivity and 2D nature of the technique. Reliability can be improved by defining a standard projection, feeding artery, and draining vein for analysis.
Highlights
BACKGROUND AND PURPOSEHemodynamic features of brain AVMs may portend increased hemorrhage risk
When the analysis was limited to cases in which the raters selected the same image to analyze and selected the same primary feeding artery and the same primary draining vein, interrater reliability improved to fair
Brain AVMs are uncommon high-flow vascular malformations that often present with intracranial hemorrhage, seizure, or headache in young adults.[1,2,3]
Summary
Thirty-five color-coded parametric DSA images of 34 brain AVMs were analyzed by 4 neuroradiologists with experience in interventional neuroradiology. Hemodynamic features assessed included MTT of the AVM and TTP of the dominant feeding artery and draining vein. ROIs of the same size were placed on the primary feeding artery and primary draining vein. ROIs were placed as close to the AVM nidus as possible with care to minimize overlap with other feeding arteries or draining veins. For each manually placed ROI, a time-versus-intensity graph was produced and exported by the software with calculated parameters of the following: 1) ROI peak time: time that the contrast intensity of a selected ROI reaches peak value; 2) ROI arrival time: time of arrival of contrast material; 3) MTT: average contrast material transit time through the target, measured as the time between the venous ROI peak and the arterial ROI peak; and 4) TTP: time elapsing from the first appearance of contrast material in the ROI
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