Interobserver Variability in Retreatment Decisions of Recurrent and Residual Aneurysms

Article Figures & Data

Table 1:

Treatment options

Options
Retreat rating scale
1) Definitely do not retreat
2) Probably do not retreat
3) Unsure
4) Probably retreat
5) Definitely retreat
Retreatment recommendation
Surgical clipping
Simple coiling
Flow diversion
Balloon-assisted coiling
Stent-assisted coiling

Table 2:

Case demographics

Demographics	n = 66
Sex (female)	46 (70%)
Age (yr)	59 (52–65)
Aneurysm type
Ruptured	45 (68%)
Unruptured	21 (32%)
Aneurysm remnant
Maximum dimension (mm) (range)	3.3 (2.7–6.0)
Dome/neck ratio (range)	0.9 (0.8–1.0)
Height/neck ratio (range)	0.9 (0.6–1.2)
Months since embolization (range)	6.6 (5.8–10.2)
mRS score
0	21 (32%)
1	28 (42%)
2	9 (14%)
3	8 (12%)
Smoking history
Current	22 (33%)
Previous	25 (38%)
Never	19 (29%)
Family history
None	57 (86%)
First-order relative	7 (11%)
Second-order relative	2 (3%)

Table 3:

Interclass correlation coefficients

Decision to Retreat	ICC (95% CI)
All readers	0.50 (0.40–0.61)
Neuroradiologists	0.48 (0.35–0.60)
Neurosurgeons	0.59 (0.46–0.71)
Readers with <5 years' experience	0.45 (0.30–0.60)
Readers with ≥10 years' experience	0.52 (0.37–0.65)
Treatment type
All readers	0.25 (0.14–0.41)
Neuroradiologists	0.20 (0.07–0.37)
Neurosurgeons	0.25 (0.09–0.46)
Readers with <5 years' experience	0.46 (0.28–0.63)
Readers with ≥10 years' experience	0.14 (0–0.34)

Table 4:

Retreatment ratings by reader

Individual Readers	Decision to Retreat					Mean Rating (SD)	Clinically Meaningful Difference Cases	P Value (CMD Cases)	P Value (Grade 5)	P Value (Grade 1)	Total
Individual Readers	1) Definitely Do Not Retreat	2	3	4	5) Definitely Retreat	Mean Rating (SD)	Clinically Meaningful Difference Cases	P Value (CMD Cases)	P Value (Grade 5)	P Value (Grade 1)	Total
Reader 1: neuroradiologist, <5 years	11	15	12	13	15	3.1 (1.4)					66
Reader 2: neuroradiologist, 5–10 years	20	17	1	12	16	2.8 (1.6)					66
Reader 3: neuroradiologist, ≥10 years	21	9	2	13	21	3.1 (1.7)					66
Reader 4: neuroradiologist, ≥10 years	9	9	0	11	37	3.9 (1.5)					66
Reader 5: neurosurgeon, <5 years	6	4	6	10	40	4.1 (1.3)					66
Reader 6: neurosurgeon, <5 years	10	9	2	15	30	3.7 (1.5)					66
Reader 7: neurosurgeon, ≥10 years	5	14	1	21	25	3.7 (1.4)					66
Only neuroradiologists	61 (23%)	50 (19%)	15 (6%)	49 (19%)	89 (34%)	3.2 (1.6)	31 (47%)	.0007	<.0001	<.0001	264
Only neurosurgeons	21 (11%)	27 (14%)	9 (5%)	46 (23%)	95 (48%)	3.8 (1.4)	12 (18%)				198
Only <5 years' experience	27 (14%)	28 (14%)	20 (10%)	38 (19%)	85 (43%)	3.6 (1.5)	17 (26%)	.71^{^a}	.0198^{^b}	.0090^{^b}	198
Only 5–10 years' experience	20 (30%)	17 (26%)	1 (2%)	12 (18%)	16 (24%)	2.8 (1.6)	–		.92^{^a}	.33^{^a}	66
Only ≥10 years' experience	35 (18%)	32 (16%)	3 (2%)	45 (23%)	80 (40%)	3.5 (1.6)	20 (30%)				198
All readers total	82 (18%)	77 (17%)	24 (5%)	95 (21%)	184 (40%)	3.5 (1.6)	40 (61%)				462

Note:—CMD indicates a difference in score that would result in a difference in treatment.
↵a Comparing level groups with <5 years' and ≥10 years' experience only.
↵b Comparing level groups with <5 years', 5–10 years', and ≥10 years' experience.

Table 5:

Retreatment type by reader

Specialty and Experience	Retreatment Type					Total
Specialty and Experience	Surgical Clipping	Simple Coiling	Flow Diversion	Balloon-Assisted Coiling	Stent-Assisted Coiling	Total
Reader 1: neuroradiologist, <5 years	1	16	13	5	31	66
Reader 2: neuroradiologist, 5–10 years	9	6	5	26	20	66
Reader 3: neuroradiologist, ≥10 years	6	22	13	4	1	46
Reader 4: neuroradiologist, ≥10 years	20	17	1	12	16	66
Reader 5: neurosurgeon, <5 years	3	23	0	5	35	66
Reader 6: neurosurgeon, <5 years	7	2	6	7	23	45
Reader 7: neurosurgeon, ≥10 years	12	4	32	4	14	66
Only neuroradiologists	36 (15%)	61 (25%)	32 (13%)	47 (19%)	68 (28%)	244
Only neurosurgeons	22 (12%)	29 (16%)	38 (21%)	16 (9%)	72 (41%)	177
Only <5 years' experience	11 (6%)	41 (23%)	19 (11%)	17 (10%)	89 (50%)	177
Only 5–10 years' experience	9 (14%)	6 (9%)	5 (8%)	26 (39%)	20 (30%)	66
Only ≥10 years' experience	38 (21%)	43 (24%)	46 (26%)	20 (11%)	31 (17%)	178
All readers total	58 (14%)	90 (21%)	70 (17%)	63 (15%)	140 (33%)	421