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<meta name="DC.Title" content="Inter- and Intraobserver Agreement in CT Characterization of Nonaneurysmal Perimesencephalic Subarachnoid Hemorrhage" />
<meta name="DC.Identifier" content="10.3174/ajnr.A1988" />
<meta name="DC.Date" content="2010-06-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: The perimesencephalic pattern of SAH as seen on unenhanced CT is associated with significantly better outcomes when compared to an aneurysmal pattern of SAH. The aim of this study was to determine the degree of inter- and intraoberver agreement for characterization of the NAPH as seen on unenhanced CT.

MATERIALS AND METHODS: We retrospectively reviewed the CT scans of 37 patients with spontaneous SAH, all of whom had undergone CT within 24 hours of onset of headache symptoms. All patients had undergone conventional cerebral angiography to confirm or exclude aneurysms or other vascular pathology. All 37 cases were angiographically confirmed nonaneurysmal SAHs. Four readers with neuroradiology subspecialty training independently evaluated CT images to characterize the hemorrhage pattern as compatible with the well-described NAPH. Each reader performed a second reading session blinded to the initial readings. The first and second sets of readings were performed approximately 4 months apart. Inter- and intraobserver agreement for characterization of the NAPH was determined by using the κ statistic.

RESULTS: Of the 37 angiographically confirmed nonaneurysmal SAHs, there was unanimous agreement as to the hemorrhage pattern in 29 (78%) cases and disagreement in 8 (22%) cases. Overall, intraobserver agreement was good (κ = 0.80). Interobserver agreement was also good (κ = 0.79).

CONCLUSIONS: Overall, inter- and intraobserver agreement for the NAPH was good. There was, however, a level of disagreement among observers, thus suggesting that clinicians should be cautious when deciding whether to pursue follow-up imaging.

CTA
:   CT angiography
DSA
:   digital subtraction angiography
NAPH
:   nonaneurysmal perimesencephalic subarachnoid hemorrhage
SAH
:   subarachnoid hemorrhage" />
<meta name="DC.Contributor" content="W. Brinjikji" />
<meta name="DC.Contributor" content="D.F. Kallmes" />
<meta name="DC.Contributor" content="J.B. White" />
<meta name="DC.Contributor" content="G. Lanzino" />
<meta name="DC.Contributor" content="J.M. Morris" />
<meta name="DC.Contributor" content="H.J Cloft" />
<meta name="article:published_time" content="2010-06-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Inter- and Intraobserver Agreement in CT Characterization of Nonaneurysmal Perimesencephalic Subarachnoid Hemorrhage" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;The perimesencephalic pattern of SAH as seen on unenhanced CT is associated with significantly better outcomes when compared to an aneurysmal pattern of SAH. The aim of this study was to determine the degree of inter- and intraoberver agreement for characterization of the NAPH as seen on unenhanced CT.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We retrospectively reviewed the CT scans of 37 patients with spontaneous SAH, all of whom had undergone CT within 24 hours of onset of headache symptoms. All patients had undergone conventional cerebral angiography to confirm or exclude aneurysms or other vascular pathology. All 37 cases were angiographically confirmed nonaneurysmal SAHs. Four readers with neuroradiology subspecialty training independently evaluated CT images to characterize the hemorrhage pattern as compatible with the well-described NAPH. Each reader performed a second reading session blinded to the initial readings. The first and second sets of readings were performed approximately 4 months apart. Inter- and intraobserver agreement for characterization of the NAPH was determined by using the κ statistic.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Of the 37 angiographically confirmed nonaneurysmal SAHs, there was unanimous agreement as to the hemorrhage pattern in 29 (78%) cases and disagreement in 8 (22%) cases. Overall, intraobserver agreement was good (κ = 0.80). Interobserver agreement was also good (κ = 0.79).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Overall, inter- and intraobserver agreement for the NAPH was good. There was, however, a level of disagreement among observers, thus suggesting that clinicians should be cautious when deciding whether to pursue follow-up imaging.&lt;/p&gt;" />
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<meta name="citation_reference" content="citation_journal_title=American Journal of Neuroradiology;citation_journal_abbrev=Am. J. Neuroradiol.;citation_author=GJ. Rinkel;citation_author=EF. Wijdicks;citation_author=M. Vermeulen;citation_title=Nonaneurysmal perimesencephalic subarachnoid hemorrhage: CT and MR patterns that differ from aneurysmal rupture.;citation_pages=829-834;citation_volume=12;citation_year=1991;citation_issue=5;citation_issn=0195-6108;citation_pmid=1950905" />
<meta name="twitter:title" content="Inter- and Intraobserver Agreement in CT Characterization of Nonaneurysmal Perimesencephalic Subarachnoid Hemorrhage" />
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<meta name="twitter:image" content="http://ajnr-stage2.stage.highwire.org/sites/default/files/highwire/ajnr/31/6.cover.gif" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: The perimesencephalic pattern of SAH as seen on unenhanced CT is associated with significantly better outcomes when compared to an aneurysmal pattern of SAH. The aim of this study was to determine the degree of inter- and intraoberver agreement for characterization of the NAPH as seen on unenhanced CT.

MATERIALS AND METHODS: We retrospectively reviewed the CT scans of 37 patients with spontaneous SAH, all of whom had undergone CT within 24 hours of onset of headache symptoms. All patients had undergone conventional cerebral angiography to confirm or exclude aneurysms or other vascular pathology. All 37 cases were angiographically confirmed nonaneurysmal SAHs. Four readers with neuroradiology subspecialty training independently evaluated CT images to characterize the hemorrhage pattern as compatible with the well-described NAPH. Each reader performed a second reading session blinded to the initial readings. The first and second sets of readings were performed approximately 4 months apart. Inter- and intraobserver agreement for characterization of the NAPH was determined by using the κ statistic.

RESULTS: Of the 37 angiographically confirmed nonaneurysmal SAHs, there was unanimous agreement as to the hemorrhage pattern in 29 (78%) cases and disagreement in 8 (22%) cases. Overall, intraobserver agreement was good (κ = 0.80). Interobserver agreement was also good (κ = 0.79).

CONCLUSIONS: Overall, inter- and intraobserver agreement for the NAPH was good. There was, however, a level of disagreement among observers, thus suggesting that clinicians should be cautious when deciding whether to pursue follow-up imaging.

CTA
:   CT angiography
DSA
:   digital subtraction angiography
NAPH
:   nonaneurysmal perimesencephalic subarachnoid hemorrhage
SAH
:   subarachnoid hemorrhage" />
<meta name="og-title" property="og:title" content="Inter- and Intraobserver Agreement in CT Characterization of Nonaneurysmal Perimesencephalic Subarachnoid Hemorrhage" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/6/1103" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: The perimesencephalic pattern of SAH as seen on unenhanced CT is associated with significantly better outcomes when compared to an aneurysmal pattern of SAH. The aim of this study was to determine the degree of inter- and intraoberver agreement for characterization of the NAPH as seen on unenhanced CT.

MATERIALS AND METHODS: We retrospectively reviewed the CT scans of 37 patients with spontaneous SAH, all of whom had undergone CT within 24 hours of onset of headache symptoms. All patients had undergone conventional cerebral angiography to confirm or exclude aneurysms or other vascular pathology. All 37 cases were angiographically confirmed nonaneurysmal SAHs. Four readers with neuroradiology subspecialty training independently evaluated CT images to characterize the hemorrhage pattern as compatible with the well-described NAPH. Each reader performed a second reading session blinded to the initial readings. The first and second sets of readings were performed approximately 4 months apart. Inter- and intraobserver agreement for characterization of the NAPH was determined by using the κ statistic.

RESULTS: Of the 37 angiographically confirmed nonaneurysmal SAHs, there was unanimous agreement as to the hemorrhage pattern in 29 (78%) cases and disagreement in 8 (22%) cases. Overall, intraobserver agreement was good (κ = 0.80). Interobserver agreement was also good (κ = 0.79).

CONCLUSIONS: Overall, inter- and intraobserver agreement for the NAPH was good. There was, however, a level of disagreement among observers, thus suggesting that clinicians should be cautious when deciding whether to pursue follow-up imaging.

CTA
:   CT angiography
DSA
:   digital subtraction angiography
NAPH
:   nonaneurysmal perimesencephalic subarachnoid hemorrhage
SAH
:   subarachnoid hemorrhage" />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">W. Brinjikji</span>, <span class="highwire-citation-author" data-delta="1">D.F. Kallmes</span>, <span class="highwire-citation-author" data-delta="2">J.B. White</span>, <span class="highwire-citation-author" data-delta="3">G. Lanzino</span>, <span class="highwire-citation-author" data-delta="4">J.M. Morris</span> and <span class="highwire-citation-author" data-delta="5">H.J Cloft</span></span></div>
  
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<div id="hw-article-author-popups-top-node-9920--6691869010" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">W. Brinjikji </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=W.%2BBrinjikji%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Brinjikji%20W&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AW.%2BBrinjikji%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">D.F. 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Lanzino </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BLanzino%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lanzino%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AG.%2BLanzino%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">J.M. 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<p id="p-3"><strong>BACKGROUND AND PURPOSE:</strong> The perimesencephalic pattern of SAH as seen on unenhanced CT is associated with significantly better outcomes when compared to an aneurysmal pattern of SAH. The aim of this study was to determine the degree of inter- and intraoberver agreement for characterization of the NAPH as seen on unenhanced CT.</p>
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<p id="p-4"><strong>MATERIALS AND METHODS:</strong> We retrospectively reviewed the CT scans of 37 patients with spontaneous SAH, all of whom had undergone CT within 24 hours of onset of headache symptoms. All patients had undergone conventional cerebral angiography to confirm or exclude aneurysms or other vascular pathology. All 37 cases were angiographically confirmed nonaneurysmal SAHs. Four readers with neuroradiology subspecialty training independently evaluated CT images to characterize the hemorrhage pattern as compatible with the well-described NAPH. Each reader performed a second reading session blinded to the initial readings. The first and second sets of readings were performed approximately 4 months apart. Inter- and intraobserver agreement for characterization of the NAPH was determined by using the κ statistic.</p>
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<p id="p-5"><strong>RESULTS:</strong> Of the 37 angiographically confirmed nonaneurysmal SAHs, there was unanimous agreement as to the hemorrhage pattern in 29 (78%) cases and disagreement in 8 (22%) cases. Overall, intraobserver agreement was good (κ = 0.80). Interobserver agreement was also good (κ = 0.79).</p>
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<div id="sec-4" class="subsection">
 
<p id="p-6"><strong>CONCLUSIONS:</strong> Overall, inter- and intraobserver agreement for the NAPH was good. There was, however, a level of disagreement among observers, thus suggesting that clinicians should be cautious when deciding whether to pursue follow-up imaging.</p>
</div></div><div class="section glossary" id="glossary-1"><h2>Abbreviations</h2><dl id="def-list-1"><dt id="def-item-1">CTA<span class="def-item-dt-sep"></span></dt><dd>CT angiography<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">DSA<span class="def-item-dt-sep"></span></dt><dd>digital subtraction angiography<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">NAPH<span class="def-item-dt-sep"></span></dt><dd>nonaneurysmal perimesencephalic subarachnoid hemorrhage<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">SAH<span class="def-item-dt-sep"></span></dt><dd>subarachnoid hemorrhage</dd></dl></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">Copyright © American Society of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/31/6/1103.full" class="hw-link hw-link-article-full-text" data-icon-position="" data-hide-link-title="0">View Full Text</a></div>  </div>

  
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">W.</span> <span class="nlm-surname">Brinjikji</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">D.F.</span> <span class="nlm-surname">Kallmes</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">J.B.</span> <span class="nlm-surname">White</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Lanzino</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.M.</span> <span class="nlm-surname">Morris</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">H.J</span> <span class="nlm-surname">Cloft</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jun 2010, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1103-1105; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A1988 </span></div>
  
  
  
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