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<meta name="HW.identifier" content="/ajnr/early/2020/10/29/ajnr.A6846.atom" />
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<meta name="DC.Format" content="text/html" />
<meta name="DC.Language" content="en" />
<meta name="DC.Title" content="Interrater Reliability in the Measurement of Flow Characteristics on Color-Coded Quantitative DSA of Brain AVMs" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6846" />
<meta name="DC.Date" content="2020-10-29" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2020 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Hemodynamic features of brain AVMs may portend increased hemorrhage risk. Previous studies have suggested that MTT is shorter in ruptured AVMs as assessed on quantitative color-coded parametric DSA. This study assesses the interrater reliability of MTT measurements obtained using quantitative color-coded DSA.

MATERIALS AND METHODS: Thirty-five color-coded parametric DSA images of 34 brain AVMs were analyzed by 4 neuroradiologists with experience in interventional neuroradiology. Hemodynamic features assessed included MTT of the AVM and TTP of the dominant feeding artery and draining vein. Agreement among the 4 raters was assessed using the intraclass correlation coefficient.

RESULTS: The interrater reliability among the 4 raters was poor (intraclass correlation coefficient = 0.218; 95% CI, 0.062–0.414; P value = .002) as it related to MTT assessment. When the analysis was limited to cases in which the raters selected the same image to analyze and selected the same primary feeding artery and the same primary draining vein, interrater reliability improved to fair (intraclass correlation coefficient  = 0.564; 95% CI, 0.367–0.717; P  &lt; .001).

CONCLUSIONS: Interrater reliability in deriving color-coded parametric DSA measurements such as MTT is poor so minor differences among raters may result in a large variance in MTT and TTP results, partly due to the sensitivity and 2D nature of the technique. Reliability can be improved by defining a standard projection, feeding artery, and draining vein for analysis.

AUC
:   area under the curve
bAVM
:   brain AVM
cDSA
:   color-coded parametric quantitative DSA
ICC
:   intraclass correlation coefficient
IQR
:   interquartile range
PCA
:   posterior cerebral artery
SCA
:   superior cerebellar artery" />
<meta name="DC.Contributor" content="K.H Narsinh" />
<meta name="DC.Contributor" content="K. Mueller" />
<meta name="DC.Contributor" content="J. Nelson" />
<meta name="DC.Contributor" content="J. Massachi" />
<meta name="DC.Contributor" content="D.C. Murph" />
<meta name="DC.Contributor" content="A.Z. Copelan" />
<meta name="DC.Contributor" content="S.W. Hetts" />
<meta name="DC.Contributor" content="V.V. Halbach" />
<meta name="DC.Contributor" content="R.T. Higashida" />
<meta name="DC.Contributor" content="A.A. Abla" />
<meta name="DC.Contributor" content="M.R. Amans" />
<meta name="DC.Contributor" content="C.F. Dowd" />
<meta name="DC.Contributor" content="H. Kim" />
<meta name="DC.Contributor" content="D.L. Cooke" />
<meta name="article:published_time" content="2020-10-29" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="Interrater Reliability in the Measurement of Flow Characteristics on Color-Coded Quantitative DSA of Brain AVMs" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Hemodynamic features of brain AVMs may portend increased hemorrhage risk. Previous studies have suggested that MTT is shorter in ruptured AVMs as assessed on quantitative color-coded parametric DSA. This study assesses the interrater reliability of MTT measurements obtained using quantitative color-coded DSA.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Thirty-five color-coded parametric DSA images of 34 brain AVMs were analyzed by 4 neuroradiologists with experience in interventional neuroradiology. Hemodynamic features assessed included MTT of the AVM and TTP of the dominant feeding artery and draining vein. Agreement among the 4 raters was assessed using the intraclass correlation coefficient.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The interrater reliability among the 4 raters was poor (intraclass correlation coefficient = 0.218; 95% CI, 0.062–0.414; &lt;i&gt;P&lt;/i&gt; value = .002) as it related to MTT assessment. When the analysis was limited to cases in which the raters selected the same image to analyze and selected the same primary feeding artery and the same primary draining vein, interrater reliability improved to fair (intraclass correlation coefficient  = 0.564; 95% CI, 0.367–0.717; &lt;i&gt;P &lt;/i&gt;&amp;lt; .001).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Interrater reliability in deriving color-coded parametric DSA measurements such as MTT is poor so minor differences among raters may result in a large variance in MTT and TTP results, partly due to the sensitivity and 2D nature of the technique. Reliability can be improved by defining a standard projection, feeding artery, and draining vein for analysis.&lt;/p&gt;" />
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<meta name="twitter:title" content="Interrater Reliability in the Measurement of Flow Characteristics on Color-Coded Quantitative DSA of Brain AVMs" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Hemodynamic features of brain AVMs may portend increased hemorrhage risk. Previous studies have suggested that MTT is shorter in ruptured AVMs as assessed on quantitative color-coded parametric DSA. This study assesses the interrater reliability of MTT measurements obtained using quantitative color-coded DSA.

MATERIALS AND METHODS: Thirty-five color-coded parametric DSA images of 34 brain AVMs were analyzed by 4 neuroradiologists with experience in interventional neuroradiology. Hemodynamic features assessed included MTT of the AVM and TTP of the dominant feeding artery and draining vein. Agreement among the 4 raters was assessed using the intraclass correlation coefficient.

RESULTS: The interrater reliability among the 4 raters was poor (intraclass correlation coefficient = 0.218; 95% CI, 0.062–0.414; P value = .002) as it related to MTT assessment. When the analysis was limited to cases in which the raters selected the same image to analyze and selected the same primary feeding artery and the same primary draining vein, interrater reliability improved to fair (intraclass correlation coefficient  = 0.564; 95% CI, 0.367–0.717; P  &lt; .001).

CONCLUSIONS: Interrater reliability in deriving color-coded parametric DSA measurements such as MTT is poor so minor differences among raters may result in a large variance in MTT and TTP results, partly due to the sensitivity and 2D nature of the technique. Reliability can be improved by defining a standard projection, feeding artery, and draining vein for analysis.

AUC
:   area under the curve
bAVM
:   brain AVM
cDSA
:   color-coded parametric quantitative DSA
ICC
:   intraclass correlation coefficient
IQR
:   interquartile range
PCA
:   posterior cerebral artery
SCA
:   superior cerebellar artery" />
<meta name="og-title" property="og:title" content="Interrater Reliability in the Measurement of Flow Characteristics on Color-Coded Quantitative DSA of Brain AVMs" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2020/10/29/ajnr.A6846" />
<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: Hemodynamic features of brain AVMs may portend increased hemorrhage risk. Previous studies have suggested that MTT is shorter in ruptured AVMs as assessed on quantitative color-coded parametric DSA. This study assesses the interrater reliability of MTT measurements obtained using quantitative color-coded DSA.

MATERIALS AND METHODS: Thirty-five color-coded parametric DSA images of 34 brain AVMs were analyzed by 4 neuroradiologists with experience in interventional neuroradiology. Hemodynamic features assessed included MTT of the AVM and TTP of the dominant feeding artery and draining vein. Agreement among the 4 raters was assessed using the intraclass correlation coefficient.

RESULTS: The interrater reliability among the 4 raters was poor (intraclass correlation coefficient = 0.218; 95% CI, 0.062–0.414; P value = .002) as it related to MTT assessment. When the analysis was limited to cases in which the raters selected the same image to analyze and selected the same primary feeding artery and the same primary draining vein, interrater reliability improved to fair (intraclass correlation coefficient  = 0.564; 95% CI, 0.367–0.717; P  &lt; .001).

CONCLUSIONS: Interrater reliability in deriving color-coded parametric DSA measurements such as MTT is poor so minor differences among raters may result in a large variance in MTT and TTP results, partly due to the sensitivity and 2D nature of the technique. Reliability can be improved by defining a standard projection, feeding artery, and draining vein for analysis.

AUC
:   area under the curve
bAVM
:   brain AVM
cDSA
:   color-coded parametric quantitative DSA
ICC
:   intraclass correlation coefficient
IQR
:   interquartile range
PCA
:   posterior cerebral artery
SCA
:   superior cerebellar artery" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node79548--5" data-node-nid="79548" id="top-node-79548--6890405623" data-pisa="ajnr;ajnr.A6846v1" data-pisa-master="ajnr;ajnr.A6846" data-apath="/ajnr/early/2020/10/29/ajnr.A6846.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"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Interrater Reliability in the Measurement of Flow Characteristics on Color-Coded Quantitative DSA of Brain AVMs</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">K.H Narsinh</span>, <span class="highwire-citation-author" data-delta="1">K. Mueller</span>, <span class="highwire-citation-author" data-delta="2">J. Nelson</span>, <span class="highwire-citation-author" data-delta="3">J. Massachi</span>, <span class="highwire-citation-author" data-delta="4">D.C. Murph</span>, <span class="highwire-citation-author" data-delta="5">A.Z. Copelan</span>, <span class="highwire-citation-author" data-delta="6">S.W. Hetts</span>, <span class="highwire-citation-author" data-delta="7">V.V. Halbach</span>, <span class="highwire-citation-author" data-delta="8">R.T. Higashida</span>, <span class="highwire-citation-author" data-delta="9">A.A. Abla</span>, <span class="highwire-citation-author" data-delta="10">M.R. Amans</span>, <span class="highwire-citation-author" data-delta="11">C.F. Dowd</span>, <span class="highwire-citation-author" data-delta="12">H. Kim</span> and <span class="highwire-citation-author" data-delta="13">D.L. Cooke</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">October 2020,  </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6846 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-79548--6890405623" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">K.H Narsinh </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 Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)</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=K.H%2BNarsinh%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=Narsinh%20K&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%3AK.H%2BNarsinh%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/0000-0002-2019-5461" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K.H Narsinh</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">K. Mueller </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Siemens Medical Solutions (K.M.), Malvern, Pennsylvania.</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=K.%2BMueller%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=Mueller%20K&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%3AK.%2BMueller%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/0000-0002-8787-2623" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for K. Mueller</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">J. Nelson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Center for Cerebrovascular Research (J.N., H.K.), Department of Anesthesiology</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.%2BNelson%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=Nelson%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.%2BNelson%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/0000-0002-0219-473X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Nelson</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">J. Massachi </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 Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)</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.%2BMassachi%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=Massachi%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.%2BMassachi%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/0000-0001-8645-5740" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Massachi</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">D.C. Murph </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 Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)</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=D.C.%2BMurph%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=Murph%20D&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%3AD.C.%2BMurph%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/0000-0003-4718-5420" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.C. Murph</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">A.Z. Copelan </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 Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)</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.Z.%2BCopelan%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=Copelan%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.Z.%2BCopelan%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/0000-0002-3212-6084" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.Z. Copelan</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">S.W. Hetts </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 Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)</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=S.W.%2BHetts%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=Hetts%20S&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%3AS.W.%2BHetts%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/0000-0001-5885-7259" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S.W. Hetts</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">V.V. Halbach </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 Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)</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=V.V.%2BHalbach%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=Halbach%20V&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%3AV.V.%2BHalbach%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/0000-0001-7138-2307" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for V.V. Halbach</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">R.T. Higashida </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 Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)</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=R.T.%2BHigashida%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=Higashida%20R&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%3AR.T.%2BHigashida%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/0000-0002-8863-2656" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R.T. Higashida</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">A.A. Abla </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Department of Neurological Surgery (A.A.A.), University of California San Francisco, San Francisco, California</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.A.%2BAbla%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=Abla%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.A.%2BAbla%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/0000-0002-6941-2295" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A.A. Abla</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">M.R. Amans </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 Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)</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.R.%2BAmans%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=Amans%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.R.%2BAmans%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/0000-0002-8209-0534" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.R. Amans</a></li></ul></div><div class="author-tooltip-11"><div class="author-tooltip-name">C.F. Dowd </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 Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)</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=C.F.%2BDowd%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=Dowd%20C&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%3AC.F.%2BDowd%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/0000-0003-2267-4244" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C.F. Dowd</a></li></ul></div><div class="author-tooltip-12"><div class="author-tooltip-name">H. Kim </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Center for Cerebrovascular Research (J.N., H.K.), Department of Anesthesiology</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=H.%2BKim%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=Kim%20H&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%3AH.%2BKim%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/0000-0002-1937-354X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for H. Kim</a></li></ul></div><div class="author-tooltip-13"><div class="author-tooltip-name">D.L. Cooke </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 Radiology and Biomedical Imaging (K.H.N., J.M., D.C.M., A.Z.C., S.W.H., V.V.H., R.T.H., M.R.A., C.F.D., D.L.C.)</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=D.L.%2BCooke%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=Cooke%20D&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%3AD.L.%2BCooke%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/0000-0002-3694-413X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.L. Cooke</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><div id="sec-1" class="subsection"><p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> Hemodynamic features of brain AVMs may portend increased hemorrhage risk. Previous studies have suggested that MTT is shorter in ruptured AVMs as assessed on quantitative color-coded parametric DSA. This study assesses the interrater reliability of MTT measurements obtained using quantitative color-coded DSA.</p></div><div id="sec-2" class="subsection"><p id="p-3"><strong>MATERIALS AND METHODS:</strong> Thirty-five color-coded parametric DSA images of 34 brain AVMs were analyzed by 4 neuroradiologists with experience in interventional neuroradiology. Hemodynamic features assessed included MTT of the AVM and TTP of the dominant feeding artery and draining vein. Agreement among the 4 raters was assessed using the intraclass correlation coefficient.</p></div><div id="sec-3" class="subsection"><p id="p-4"><strong>RESULTS:</strong> The interrater reliability among the 4 raters was poor (intraclass correlation coefficient = 0.218; 95% CI, 0.062–0.414; <em>P</em> value = .002) as it related to MTT assessment. When the analysis was limited to cases in which the raters selected the same image to analyze and selected the same primary feeding artery and the same primary draining vein, interrater reliability improved to fair (intraclass correlation coefficient  = 0.564; 95% CI, 0.367–0.717; <em>P </em>&lt; .001).</p></div><div id="sec-4" class="subsection"><p id="p-5"><strong>CONCLUSIONS:</strong> Interrater reliability in deriving color-coded parametric DSA measurements such as MTT is poor so minor differences among raters may result in a large variance in MTT and TTP results, partly due to the sensitivity and 2D nature of the technique. Reliability can be improved by defining a standard projection, feeding artery, and draining vein for analysis.</p></div></div><div class="section glossary" id="glossary-1"><h2 class="">ABBREVIATIONS:</h2><dl id="def-list-1"><dt id="def-item-1">AUC<span class="def-item-dt-sep"></span></dt><dd>area under the curve<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">bAVM<span class="def-item-dt-sep"></span></dt><dd>brain AVM<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">cDSA<span class="def-item-dt-sep"></span></dt><dd>color-coded parametric quantitative DSA<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">ICC<span class="def-item-dt-sep"></span></dt><dd>intraclass correlation coefficient<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">IQR<span class="def-item-dt-sep"></span></dt><dd>interquartile range<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">PCA<span class="def-item-dt-sep"></span></dt><dd>posterior cerebral artery<span class="def-item-dd-sep"></span></dd><dt id="def-item-7">SCA<span class="def-item-dt-sep"></span></dt><dd>superior cerebellar artery</dd></dl></div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn-other" id="fn-2"><p id="p-48">This work was supported by National Institutes of Health National Institute of Neurological Disorders and Stroke R01grant NS099628 and NIH NINDS U54 NS065705.</p></li><li class="fn-financial-disclosure" id="fn-3"><p id="p-49">Disclosures: Jeffrey Nelson—<em>RELATED</em>: <em>Grant</em>: National Institutes of Health.* Kerstin Mueller—<em>RELATED</em>: <em>Other</em>: employed by Siemens; <em>UNRELATED</em>: <em>Employment</em>: Siemens. Steven W. Hetts—<em>UNRELATED: Grants/Grants Pending</em>: Siemens, <em>Comments</em>: research contracts for X-ray angiography systems*. Christopher F. Dowd—<em>UNRELATED</em>: <em>Other</em>: Stryker, <em>Comments</em>: I serve as Chief Adjudicator of the Angio Core Lab for the EVOLVE flow-diverter clinical trial (department salary support).* Helen Kim—<em>RELATED</em>: <em>Grant</em>: National Institutes of Health, <em>Comments</em>: R01NS034949.* *Money paid to institution.</p></li></ul></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2020 by American Journal of Neuroradiology</li></ul><div class="license" id="license-1"><p id="p-1">Indicates open access to non-subscribers at <a href="http://www.ajnr.org" rel="license">www.ajnr.org</a></p></div><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div><a href="http://ajnr-stage2.stage.highwire.org/content/early/2020/10/29/ajnr.A6846.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-title">Interrater Reliability in the Measurement of Flow Characteristics on Color-Coded Quantitative DSA of Brain AVMs</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">K.H</span> <span class="nlm-surname">Narsinh</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Mueller</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Nelson</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Massachi</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">D.C.</span> <span class="nlm-surname">Murph</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">A.Z.</span> <span class="nlm-surname">Copelan</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">S.W.</span> <span class="nlm-surname">Hetts</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">V.V.</span> <span class="nlm-surname">Halbach</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">R.T.</span> <span class="nlm-surname">Higashida</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">A.A.</span> <span class="nlm-surname">Abla</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">M.R.</span> <span class="nlm-surname">Amans</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">C.F.</span> <span class="nlm-surname">Dowd</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">D.L.</span> <span class="nlm-surname">Cooke</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2020, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6846 </span></div>
  
  
  
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      <div class="highwire-cite-title">Interrater Reliability in the Measurement of Flow Characteristics on Color-Coded Quantitative DSA of Brain AVMs</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">K.H</span> <span class="nlm-surname">Narsinh</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">K.</span> <span class="nlm-surname">Mueller</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Nelson</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Massachi</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">D.C.</span> <span class="nlm-surname">Murph</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">A.Z.</span> <span class="nlm-surname">Copelan</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">S.W.</span> <span class="nlm-surname">Hetts</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">V.V.</span> <span class="nlm-surname">Halbach</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">R.T.</span> <span class="nlm-surname">Higashida</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">A.A.</span> <span class="nlm-surname">Abla</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">M.R.</span> <span class="nlm-surname">Amans</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">C.F.</span> <span class="nlm-surname">Dowd</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">H.</span> <span class="nlm-surname">Kim</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">D.L.</span> <span class="nlm-surname">Cooke</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Oct 2020, </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6846 </span></div>
  
  
  
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