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<meta name="DC.Title" content="Factors Influencing Confidence in Diagnostic Ratings and Retreatment Recommendations in Coiled Aneurysms" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5581" />
<meta name="DC.Date" content="2018-05-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Angiographic occlusion and retreatment of coiled aneurysms are commonly used as surrogate end points in clinical trials. We aimed to evaluate the influence of aneurysm, patient, and rater characteristics on the confidence of visual evaluation of aneurysm coiling and retreatment decisions.

MATERIALS AND METHODS: Twenty-six participants of the Advanced Course in Endovascular Interventional Neuroradiology of the European Society of Neuroradiology were asked to evaluate digital subtraction angiography examinations of patients who had undergone endovascular coiling, by determining the grade of aneurysm occlusion, the change between immediate postprocedural and follow-up angiograms, their level of confidence, the technical difficulty of retreatment, and the best therapeutic approach. The experience, knowledge, and skills of each participant were assessed. The influence of rater and case characteristics on indicated confidence in diagnostic ratings and retreatment recommendations was analyzed.

RESULTS: Interrater reliability was moderate regarding the assessment of aneurysm occlusion grade (intraclass correlation coefficient = 0.581) and substantial regarding change (intraclass correlation coefficient = 0.776). Overall confidence in the diagnostic rating was high (median, “very certain”). Confidence was statistically significantly higher in cases that were generally rated as “worse.” The odds of recommending retreatment were significantly higher in cases that were generally rated with higher mean confidence.

CONCLUSIONS: Although overall confidence in the diagnostic rating was high, our study confirms the suboptimal interrater reliability of visual assessment of aneurysm occlusion as well as retreatment recommendations, rendering both questionable as primary outcome measures. Besides recurrence status, recommendation of retreatment is significantly influenced by patient age, aneurysm neck width, and characteristics of the therapist.

ICC
:   intraclass correlation coefficient" />
<meta name="DC.Contributor" content="M. Ernst" />
<meta name="DC.Contributor" content="L. Kriston" />
<meta name="DC.Contributor" content="M. Groth" />
<meta name="DC.Contributor" content="A.M. Frölich" />
<meta name="DC.Contributor" content="J. Fiehler" />
<meta name="DC.Contributor" content="J.-H. Buhk" />
<meta name="article:published_time" content="2018-05-01" />
<meta name="article:section" content="Interventional" />
<meta name="citation_title" content="Factors Influencing Confidence in Diagnostic Ratings and Retreatment Recommendations in Coiled Aneurysms" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Angiographic occlusion and retreatment of coiled aneurysms are commonly used as surrogate end points in clinical trials. We aimed to evaluate the influence of aneurysm, patient, and rater characteristics on the confidence of visual evaluation of aneurysm coiling and retreatment decisions.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Twenty-six participants of the Advanced Course in Endovascular Interventional Neuroradiology of the European Society of Neuroradiology were asked to evaluate digital subtraction angiography examinations of patients who had undergone endovascular coiling, by determining the grade of aneurysm occlusion, the change between immediate postprocedural and follow-up angiograms, their level of confidence, the technical difficulty of retreatment, and the best therapeutic approach. The experience, knowledge, and skills of each participant were assessed. The influence of rater and case characteristics on indicated confidence in diagnostic ratings and retreatment recommendations was analyzed.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;Interrater reliability was moderate regarding the assessment of aneurysm occlusion grade (intraclass correlation coefficient = 0.581) and substantial regarding change (intraclass correlation coefficient = 0.776). Overall confidence in the diagnostic rating was high (median, “very certain”). Confidence was statistically significantly higher in cases that were generally rated as “worse.” The odds of recommending retreatment were significantly higher in cases that were generally rated with higher mean confidence.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Although overall confidence in the diagnostic rating was high, our study confirms the suboptimal interrater reliability of visual assessment of aneurysm occlusion as well as retreatment recommendations, rendering both questionable as primary outcome measures. Besides recurrence status, recommendation of retreatment is significantly influenced by patient age, aneurysm neck width, and characteristics of the therapist.&lt;/p&gt;" />
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<meta name="twitter:title" content="Factors Influencing Confidence in Diagnostic Ratings and Retreatment Recommendations in Coiled Aneurysms" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Angiographic occlusion and retreatment of coiled aneurysms are commonly used as surrogate end points in clinical trials. We aimed to evaluate the influence of aneurysm, patient, and rater characteristics on the confidence of visual evaluation of aneurysm coiling and retreatment decisions.

MATERIALS AND METHODS: Twenty-six participants of the Advanced Course in Endovascular Interventional Neuroradiology of the European Society of Neuroradiology were asked to evaluate digital subtraction angiography examinations of patients who had undergone endovascular coiling, by determining the grade of aneurysm occlusion, the change between immediate postprocedural and follow-up angiograms, their level of confidence, the technical difficulty of retreatment, and the best therapeutic approach. The experience, knowledge, and skills of each participant were assessed. The influence of rater and case characteristics on indicated confidence in diagnostic ratings and retreatment recommendations was analyzed.

RESULTS: Interrater reliability was moderate regarding the assessment of aneurysm occlusion grade (intraclass correlation coefficient = 0.581) and substantial regarding change (intraclass correlation coefficient = 0.776). Overall confidence in the diagnostic rating was high (median, “very certain”). Confidence was statistically significantly higher in cases that were generally rated as “worse.” The odds of recommending retreatment were significantly higher in cases that were generally rated with higher mean confidence.

CONCLUSIONS: Although overall confidence in the diagnostic rating was high, our study confirms the suboptimal interrater reliability of visual assessment of aneurysm occlusion as well as retreatment recommendations, rendering both questionable as primary outcome measures. Besides recurrence status, recommendation of retreatment is significantly influenced by patient age, aneurysm neck width, and characteristics of the therapist.

ICC
:   intraclass correlation coefficient" />
<meta name="og-title" property="og:title" content="Factors Influencing Confidence in Diagnostic Ratings and Retreatment Recommendations in Coiled Aneurysms" />
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<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Angiographic occlusion and retreatment of coiled aneurysms are commonly used as surrogate end points in clinical trials. We aimed to evaluate the influence of aneurysm, patient, and rater characteristics on the confidence of visual evaluation of aneurysm coiling and retreatment decisions.

MATERIALS AND METHODS: Twenty-six participants of the Advanced Course in Endovascular Interventional Neuroradiology of the European Society of Neuroradiology were asked to evaluate digital subtraction angiography examinations of patients who had undergone endovascular coiling, by determining the grade of aneurysm occlusion, the change between immediate postprocedural and follow-up angiograms, their level of confidence, the technical difficulty of retreatment, and the best therapeutic approach. The experience, knowledge, and skills of each participant were assessed. The influence of rater and case characteristics on indicated confidence in diagnostic ratings and retreatment recommendations was analyzed.

RESULTS: Interrater reliability was moderate regarding the assessment of aneurysm occlusion grade (intraclass correlation coefficient = 0.581) and substantial regarding change (intraclass correlation coefficient = 0.776). Overall confidence in the diagnostic rating was high (median, “very certain”). Confidence was statistically significantly higher in cases that were generally rated as “worse.” The odds of recommending retreatment were significantly higher in cases that were generally rated with higher mean confidence.

CONCLUSIONS: Although overall confidence in the diagnostic rating was high, our study confirms the suboptimal interrater reliability of visual assessment of aneurysm occlusion as well as retreatment recommendations, rendering both questionable as primary outcome measures. Besides recurrence status, recommendation of retreatment is significantly influenced by patient age, aneurysm neck width, and characteristics of the therapist.

ICC
:   intraclass correlation coefficient" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node60859--5" data-node-nid="60859" id="top-node-60859--61125852148" data-pisa="ajnr;39/5/869" data-pisa-master="ajnr;ajnr.A5581" data-apath="/ajnr/39/5/869.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Interventional</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="ajnr;ajnr.A5581" data-atom-uri="/ajnr/39/5/869.atom" data-request-view="full"></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Factors Influencing Confidence in Diagnostic Ratings and Retreatment Recommendations in Coiled Aneurysms</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">M. Ernst</span>, <span class="highwire-citation-author" data-delta="1">L. Kriston</span>, <span class="highwire-citation-author" data-delta="2">M. Groth</span>, <span class="highwire-citation-author" data-delta="3">A.M. Frölich</span>, <span class="highwire-citation-author" data-delta="4">J. Fiehler</span> and <span class="highwire-citation-author" data-delta="5">J.-H. Buhk</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">May 2018,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">869-874; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5581 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-60859--61125852148" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">M. Ernst </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.G., A.M.F., J.F., J.-H.B.), Center for Radiology and Endoscopy</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=M.%2BErnst%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=Ernst%20M&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"><a href="/search/author1%3AM.%2BErnst%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2870-4109" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Ernst</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">L. Kriston </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Medical Psychology (L.K.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.</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=L.%2BKriston%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=Kriston%20L&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"><a href="/search/author1%3AL.%2BKriston%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-0748-264X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L. Kriston</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">M. Groth </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.G., A.M.F., J.F., J.-H.B.), Center for Radiology and Endoscopy</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=M.%2BGroth%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=Groth%20M&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"><a href="/search/author1%3AM.%2BGroth%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8868-4379" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Groth</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">A.M. Frölich </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.G., A.M.F., J.F., J.-H.B.), Center for Radiology and Endoscopy</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=A.M.%2BFr%C3%B6lich%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=Fr%C3%B6lich%20A&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"><a href="/search/author1%3AA.M.%2BFr%25C3%25B6lich%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-0804-1056" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.M. Frölich</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">J. Fiehler </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.G., A.M.F., J.F., J.-H.B.), Center for Radiology and Endoscopy</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=J.%2BFiehler%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=Fiehler%20J&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"><a href="/search/author1%3AJ.%2BFiehler%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8533-7478" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Fiehler</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">J.-H. Buhk </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Department of Diagnostic and Interventional Neuroradiology (M.E., M.G., A.M.F., J.F., J.-H.B.), Center for Radiology and Endoscopy</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=J.-H.%2BBuhk%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=Buhk%20J&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"><a href="/search/author1%3AJ.-H.%2BBuhk%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-8003-6446" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.-H. Buhk</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-39.5.869.1"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Cloft</span>  <span class="cit-name-given-names">HJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kaufmann</span>  <span class="cit-name-given-names">T</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kallmes</span>  <span class="cit-name-given-names">DF</span></span></li></ol><cite>. <span class="cit-article-title">Observer agreement in the assessment of endovascular aneurysm therapy and aneurysm recurrence</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2007</span>;<span class="cit-vol">28</span>:<span class="cit-fpage">497</span>–<span class="cit-lpage">500</span><span class="cit-pub-id-sep cit-pub-id-pmid-sep"> </span><span class="cit-pub-id cit-pub-id-pmid"><span class="cit-pub-id-scheme-pmid">pmid:</span>17353321</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiIyOC8zLzQ5NyI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci8zOS81Lzg2OS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-39.5.869.2" data-doi="10.3174/ajnr.A2848"><div class="cit-metadata"><ol class="cit-auth-list"><li>
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 39</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 5 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 May 2018 </div></div>
      
      
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    	<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">May 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(5) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">869-874; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5581 </span></div>
  
  
  
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