ArticleAJNR. American journal of neuroradiology2025
There Is Poor Agreement between the Subjective and Quantitative Adjudication of Aneurysm Wall Enhancement.
Article in AJNR. American journal of neuroradiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed.
- Radiomics model for risk stratification of intracranial aneurysm: a high-resolution vessel wall imaging-based study.BMC medical imaging · 2026Article
- Analysis of symptomatic brain aneurysms with three-dimensional aneurysm wall enhancement.Neurosurgical review · 2026Observational
- Intracranial vessel wall lesions on MRI: anatomical and pathological issues.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Review
- Arterial wall enhancement indicates higher reperfusion rates in non-ruptured aneurysms after endovascular treatment with stent-assisted coiling.Neuroradiology · 2025Article
- Circumferential Aneurysm Wall Enhancement Predicts Recanalization After Stent-Assisted Coiling in Small Unruptured Intracranial Aneurysms.Brain and behavior · 2025Article
- High-resolution vessel wall imaging-driven radiomic analysis for the precision prediction of intracranial aneurysm rupture risk: a promising approach.Frontiers in neuroscience · 2025Article
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Abstract
background and purposeThe determination of aneurysm wall enhancement (AWE) by human readers on visual inspection alone is subjective and prone to error. A 3D method for quantifying the signal intensity (SI) of the aneurysm enables objective determination of AWE. Interreader agreement and agreement between subjective and objective determination of AWE were assessed in this study. MATERIALS AND
methodsPatients with saccular intracranial aneurysms (IAs) were imaged with high-resolution MRI. In the subjective assessment, 2 internal adjudicators visually determined AWE if the degree of enhancement was equal to or higher than that of the pituitary stalk. An experienced internal neuroradiologist resolved disagreements. This internal adjudication was compared with an external adjudication to assess interrater agreement among centers. In the objective assessment, the distribution of SI across the aneurysm wall after normalizing the SI to the corpus callosum was determined with an in-house code. The normalized mean SI on postcontrast T1 MRI was defined as 3D-circumferential AWE (3D-CAWE). If the 3D-CAWE value was higher than 1, an IA was defined as objectively "enhancing." Interrater agreement was analyzed with κ coefficients. Intertechnique agreement between the subjective and objective assessments was performed using κ statistics. Univariate regressions were used to identify which morphologic characteristics influenced subjective adjudication of enhancement.
resultsA total of 113 IAs were analyzed. The agreement of the internal assessment was moderate (κ = 0.63), 49.5% of IAs (56) were classified as "enhancing;" and 50.5% (57) as "nonenhancing" after consensus. Interrater agreement between internal and external adjudication was weak (κ = 0.52) for the presence of AWE. There was no agreement between the subjective assessment of AWE and objective 3D-CAWE (κ = 0.16,
conclusionsSubjective adjudication of AWE has poor interrater agreement, and no agreement with an objective 3D method of determining AWE. It is also less likely than objective quantification to identify enhancement in aneurysms of >7 mm or when multiple aneurysms are present. Objective 3D quantification, such as the technique used in this study, should, therefore, be considered when assessing AWE, especially in patients with multiple aneurysms and aneurysms of >7 mm in size.
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