Intra- and inter-observer variability in intracranial aneurysm segmentation: comparison between CT angiography (semi-aut
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VASCULAR AND INTERVENTIONAL RADIOLOGY
Intra‑ and inter‑observer variability in intracranial aneurysm segmentation: comparison between CT angiography (semi‑automated segmentation software stroke VCAR) and digital subtraction angiography (3D rotational angiography) F. D’Argento1 · A. Pedicelli1 · C. Ciardi1 · E. Leone1 · M. Scarabello2 · A. Infante1 · A. Alexandre1 · E. Lozupone1 · I. Valente1 · C. Colosimo1,3 Received: 11 September 2019 / Accepted: 27 August 2020 © Italian Society of Medical Radiology 2020
Abstract Purpose To compare size and morphologic features of three-dimensional aneurysm models, obtained with a semi-automated segmentation software (Stroke VCAR, GE, USA) from cerebral CT angiography (CTA) data, to three-dimensional aneurysm models obtained with digital subtraction angiography (DSA, with 3D rotational angiography acquisition—3DRA), considered as the reference standard. Methods In this retrospective study, we reviewed 132 patients, with a total number of 137 intracranial aneurysm, who underwent CTA and subsequent DSA examination, supplemented with 3DRA. We compared neck length, short axis and long axis measured on 3DRA model to the same variables measured on 3D-CTA model by two blinded readers and to the automatic software dimensions. Therefore, statistics analysis assessed intra-observer and inter-observer variability and differences between patients with or without subarachnoid hemorrhage (SAH). Results There were no significant differences in short-axis and long-axis measurements between 3D angiographic and 3D-CTA models, while comparison of neck lengths revealed a statistically significant difference, which tended to be greater for smaller neck lengths (partial volume effect and “kissing vessels” artifact). There were significant differences between manual and automatic data measured for the same three variables, and the presence of SAH did not affect aneurysm 3D reconstruction. Inter-observer agreement resulted moderate for neck length and substantial for short axis and long axis. Conclusion The examined 3D-CTA segmentation system is a reproducible procedure for aneurysm morphologic characterization and, in particular, for assessment of aneurysm sac dimensions, but considerable carefulness is required in neck length interpretation. Keywords Innovative biotechnologies · Intracranial aneurysm · Stroke VCAR · CT angiography · Inter-observer variability
Introduction
* F. D’Argento [email protected] 1
UOC Radiologia e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
2
Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
3
Instituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
Intracranial aneurysms are pathological dilations of the cerebral arteries, potentially at risk of rupture in the subarachnoid space. Aneurysmal rupture with consequent subarachnoid hemorrhage (SAH) is a life
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