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<meta name="DC.Title" content="Effect of Core Laboratory and Multiple-Reader Interpretation of Angiographic Images on Follow-Up Outcomes of Coiled Cerebral Aneurysms: A Systematic Review and Meta-Analysis" />
<meta name="DC.Identifier" content="10.3174/ajnr.A3398" />
<meta name="DC.Date" content="2013-07-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2013 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Reported rates of recanalization following coil embolization vary widely across studies. Some confounders are known to affect outcomes but others remain questionable. In the current study, we assess differences in reported angiographic outcomes for cerebral aneurysms treated with coil embolization as a function of single vs multiple readers and site investigator vs core laboratory settings.

MATERIALS AND METHODS: Our systematic review covered 1999–2011 by using Ovid MEDLINE and EMBASE. Search terms were subarachnoid hemorrhage, intracranial aneurysms, endovascular treatment, and coiling. Inclusion criteria were &gt;50 aneurysms and available imaging follow-up. Study characteristics of interest were readers at the treating site(s) or at an independent core imaging facility, single vs multiple readers, number of aneurysms treated, mean aneurysm size, mean follow-up time, coil type, initial rupture status, and angiographic follow-up. We defined “unfavorable angiographic outcome” as either “recanalization,” &lt;90% occlusion, or “incomplete occlusion.”

RESULTS: There were 104 (2.6%) of 4022 studies that fulfilled our inclusion criteria, comprising a total of 22,134 treated aneurysms, of which 15,969 (72.1%) had reported angiographic follow-up. The overall unfavorable outcome rate was 17.8% (2955/15,969 aneurysms). Eight (7.7%) of 104 studies reported core laboratory readings in which the pooled rate of unfavorable outcomes was 0.23 (95% CI, 0.19–0.28) compared with 0.16 (95% CI, 0.14–0.18) in readings from the treating sites ( P &lt; .001). The multivariate meta-regression suggested that core laboratory interpretation was significant for unfavorable outcomes (OR, 5.60; 95% CI, 2.01–15.60; P = .001), after adjustment for initial rupture status, aneurysm size, follow-up duration, and coil type. No significant association was found with use of multiple readers.

CONCLUSIONS: Core laboratory studies tend to report higher rates of unfavorable outcomes compared with self-reported studies.

CI
:   confidence interval
ISAT
:   International Subarachnoid Aneurysm Trial
MeSH
:   Medical Subject Headings
OR
:   odds ratio" />
<meta name="DC.Contributor" content="I. Rezek" />
<meta name="DC.Contributor" content="G. Mousan" />
<meta name="DC.Contributor" content="Z. Wang" />
<meta name="DC.Contributor" content="M.H. Murad" />
<meta name="DC.Contributor" content="D.F. Kallmes" />
<meta name="article:published_time" content="2013-07-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Effect of Core Laboratory and Multiple-Reader Interpretation of Angiographic Images on Follow-Up Outcomes of Coiled Cerebral Aneurysms: A Systematic Review and Meta-Analysis" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Reported rates of recanalization following coil embolization vary widely across studies. Some confounders are known to affect outcomes but others remain questionable. In the current study, we assess differences in reported angiographic outcomes for cerebral aneurysms treated with coil embolization as a function of single vs multiple readers and site investigator vs core laboratory settings.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Our systematic review covered 1999–2011 by using Ovid MEDLINE and EMBASE. Search terms were subarachnoid hemorrhage, intracranial aneurysms, endovascular treatment, and coiling. Inclusion criteria were &amp;gt;50 aneurysms and available imaging follow-up. Study characteristics of interest were readers at the treating site(s) or at an independent core imaging facility, single vs multiple readers, number of aneurysms treated, mean aneurysm size, mean follow-up time, coil type, initial rupture status, and angiographic follow-up. We defined “unfavorable angiographic outcome” as either “recanalization,” &amp;lt;90% occlusion, or “incomplete occlusion.”&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;There were 104 (2.6%) of 4022 studies that fulfilled our inclusion criteria, comprising a total of 22,134 treated aneurysms, of which 15,969 (72.1%) had reported angiographic follow-up. The overall unfavorable outcome rate was 17.8% (2955/15,969 aneurysms). Eight (7.7%) of 104 studies reported core laboratory readings in which the pooled rate of unfavorable outcomes was 0.23 (95% CI, 0.19–0.28) compared with 0.16 (95% CI, 0.14–0.18) in readings from the treating sites (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001). The multivariate meta-regression suggested that core laboratory interpretation was significant for unfavorable outcomes (OR, 5.60; 95% CI, 2.01–15.60; &lt;i&gt;P&lt;/i&gt; = .001), after adjustment for initial rupture status, aneurysm size, follow-up duration, and coil type. No significant association was found with use of multiple readers.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Core laboratory studies tend to report higher rates of unfavorable outcomes compared with self-reported studies.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_publication_date" content="2013/07/01" />
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<meta name="citation_author" content="I. Rezek" />
<meta name="citation_author_institution" content="aFrom the Department of Radiology (I.R., D.F.K.)" />
<meta name="citation_author" content="G. Mousan" />
<meta name="citation_author_institution" content="dChildren's Hospital of Michigan (G.M.), Detroit, Michigan." />
<meta name="citation_author" content="Z. Wang" />
<meta name="citation_author_institution" content="bDivison of Preventive Medicine (Z.W., M.H.M.)" />
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<meta name="citation_author_institution" content="bDivison of Preventive Medicine (Z.W., M.H.M.)" />
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<meta name="citation_author_institution" content="aFrom the Department of Radiology (I.R., D.F.K.)" />
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<meta name="twitter:title" content="Effect of Core Laboratory and Multiple-Reader Interpretation of Angiographic Images on Follow-Up Outcomes of Coiled Cerebral Aneurysms: A Systematic Review and Meta-Analysis" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Reported rates of recanalization following coil embolization vary widely across studies. Some confounders are known to affect outcomes but others remain questionable. In the current study, we assess differences in reported angiographic outcomes for cerebral aneurysms treated with coil embolization as a function of single vs multiple readers and site investigator vs core laboratory settings.

MATERIALS AND METHODS: Our systematic review covered 1999–2011 by using Ovid MEDLINE and EMBASE. Search terms were subarachnoid hemorrhage, intracranial aneurysms, endovascular treatment, and coiling. Inclusion criteria were &gt;50 aneurysms and available imaging follow-up. Study characteristics of interest were readers at the treating site(s) or at an independent core imaging facility, single vs multiple readers, number of aneurysms treated, mean aneurysm size, mean follow-up time, coil type, initial rupture status, and angiographic follow-up. We defined “unfavorable angiographic outcome” as either “recanalization,” &lt;90% occlusion, or “incomplete occlusion.”

RESULTS: There were 104 (2.6%) of 4022 studies that fulfilled our inclusion criteria, comprising a total of 22,134 treated aneurysms, of which 15,969 (72.1%) had reported angiographic follow-up. The overall unfavorable outcome rate was 17.8% (2955/15,969 aneurysms). Eight (7.7%) of 104 studies reported core laboratory readings in which the pooled rate of unfavorable outcomes was 0.23 (95% CI, 0.19–0.28) compared with 0.16 (95% CI, 0.14–0.18) in readings from the treating sites ( P &lt; .001). The multivariate meta-regression suggested that core laboratory interpretation was significant for unfavorable outcomes (OR, 5.60; 95% CI, 2.01–15.60; P = .001), after adjustment for initial rupture status, aneurysm size, follow-up duration, and coil type. No significant association was found with use of multiple readers.

CONCLUSIONS: Core laboratory studies tend to report higher rates of unfavorable outcomes compared with self-reported studies.

CI
:   confidence interval
ISAT
:   International Subarachnoid Aneurysm Trial
MeSH
:   Medical Subject Headings
OR
:   odds ratio" />
<meta name="og-title" property="og:title" content="Effect of Core Laboratory and Multiple-Reader Interpretation of Angiographic Images on Follow-Up Outcomes of Coiled Cerebral Aneurysms: A Systematic Review and Meta-Analysis" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/34/7/1380" />
<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: Reported rates of recanalization following coil embolization vary widely across studies. Some confounders are known to affect outcomes but others remain questionable. In the current study, we assess differences in reported angiographic outcomes for cerebral aneurysms treated with coil embolization as a function of single vs multiple readers and site investigator vs core laboratory settings.

MATERIALS AND METHODS: Our systematic review covered 1999–2011 by using Ovid MEDLINE and EMBASE. Search terms were subarachnoid hemorrhage, intracranial aneurysms, endovascular treatment, and coiling. Inclusion criteria were &gt;50 aneurysms and available imaging follow-up. Study characteristics of interest were readers at the treating site(s) or at an independent core imaging facility, single vs multiple readers, number of aneurysms treated, mean aneurysm size, mean follow-up time, coil type, initial rupture status, and angiographic follow-up. We defined “unfavorable angiographic outcome” as either “recanalization,” &lt;90% occlusion, or “incomplete occlusion.”

RESULTS: There were 104 (2.6%) of 4022 studies that fulfilled our inclusion criteria, comprising a total of 22,134 treated aneurysms, of which 15,969 (72.1%) had reported angiographic follow-up. The overall unfavorable outcome rate was 17.8% (2955/15,969 aneurysms). Eight (7.7%) of 104 studies reported core laboratory readings in which the pooled rate of unfavorable outcomes was 0.23 (95% CI, 0.19–0.28) compared with 0.16 (95% CI, 0.14–0.18) in readings from the treating sites ( P &lt; .001). The multivariate meta-regression suggested that core laboratory interpretation was significant for unfavorable outcomes (OR, 5.60; 95% CI, 2.01–15.60; P = .001), after adjustment for initial rupture status, aneurysm size, follow-up duration, and coil type. No significant association was found with use of multiple readers.

CONCLUSIONS: Core laboratory studies tend to report higher rates of unfavorable outcomes compared with self-reported studies.

CI
:   confidence interval
ISAT
:   International Subarachnoid Aneurysm Trial
MeSH
:   Medical Subject Headings
OR
:   odds ratio" />
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    <title>Effect of Core Laboratory and Multiple-Reader Interpretation of Angiographic Images on Follow-Up Outcomes of Coiled Cerebral Aneurysms: A Systematic Review and Meta-Analysis | American Journal of Neuroradiology</title>  
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      <h1 class="highwire-cite-title" id="page-title">Effect of Core Laboratory and Multiple-Reader Interpretation of Angiographic Images on Follow-Up Outcomes of Coiled Cerebral Aneurysms: A Systematic Review and Meta-Analysis</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">I. Rezek</span>, <span class="highwire-citation-author" data-delta="1">G. Mousan</span>, <span class="highwire-citation-author" data-delta="2">Z. Wang</span>, <span class="highwire-citation-author" data-delta="3">M.H. Murad</span> and <span class="highwire-citation-author" data-delta="4">D.F. Kallmes</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">July 2013,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1380-1384; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3398 </span></div>
  
  
  
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Mousan </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Children's Hospital of Michigan (G.M.), Detroit, Michigan.</div></span></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.%2BMousan%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=Mousan%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.%2BMousan%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-2"><div class="author-tooltip-name">Z. Wang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Divison of Preventive Medicine (Z.W., M.H.M.)</div></span></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=Z.%2BWang%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=Wang%20Z&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%3AZ.%2BWang%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-3"><div class="author-tooltip-name">M.H. 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      <div class="highwire-cite-title">Effect of Core Laboratory and Multiple-Reader Interpretation of Angiographic Images on Follow-Up Outcomes of Coiled Cerebral Aneurysms: A Systematic Review and Meta-Analysis</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">I.</span> <span class="nlm-surname">Rezek</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Mousan</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Z.</span> <span class="nlm-surname">Wang</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">M.H.</span> <span class="nlm-surname">Murad</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">D.F.</span> <span class="nlm-surname">Kallmes</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">Jul 2013, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1380-1384; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3398 </span></div>
  
  
  
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      <div class="highwire-cite-title">Effect of Core Laboratory and Multiple-Reader Interpretation of Angiographic Images on Follow-Up Outcomes of Coiled Cerebral Aneurysms: A Systematic Review and Meta-Analysis</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">I.</span> <span class="nlm-surname">Rezek</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Mousan</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Z.</span> <span class="nlm-surname">Wang</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">M.H.</span> <span class="nlm-surname">Murad</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">D.F.</span> <span class="nlm-surname">Kallmes</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">Jul 2013, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">34 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1380-1384; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A3398 </span></div>
  
  
  
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