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Benomar A, Diestro JDB, Darabid H, Saydy K, Tzaneva L, Li J, Zarour E, Tanguay W, El Sayed N, Padilha IG, Létourneau-Guillon L, Bard C, Nelson K, Weill A, Roy D, Eneling J, Boisseau W, Nguyen TN, Abdalkader M, Najjar AA, Nehme A, Lemoine É, Jacquin G, Bergeron D, Brunette-Clément T, Chaalala C, Bojanowski MW, Labidi M, Jabre R, Ignacio KHD, Omar AT, Volders D, Dmytriw AA, Hak JF, Forestier G, Holay Q, Olatunji R, Alhabli I, Nico L, Shankar JJS, Guenego A, Pascual JLR, Marotta TR, Errázuriz JI, Lin AW, Alves AC, Fahed R, Hawkes C, Lee H, Magro E, Sheikhi L, Darsaut TE, Raymond J. Nonaneurysmal perimesencephalic subarachnoid hemorrhage on noncontrast head CT: An accuracy, inter-rater, and intra-rater reliability study. J Neuroradiol 2024:S0150-9861(24)00092-0. [PMID: 38387650 DOI: 10.1016/j.neurad.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND PURPOSE To evaluate the reliability and accuracy of nonaneurysmal perimesencephalic subarachnoid hemorrhage (NAPSAH) on Noncontrast Head CT (NCCT) between numerous raters. MATERIALS AND METHODS 45 NCCT of adult patients with SAH who also had a catheter angiography (CA) were independently evaluated by 48 diverse raters; 45 raters performed a second assessment one month later. For each case, raters were asked: 1) whether they judged the bleeding pattern to be perimesencephalic; 2) whether there was blood anterior to brainstem; 3) complete filling of the anterior interhemispheric fissure (AIF); 4) extension to the lateral part of the sylvian fissure (LSF); 5) frank intraventricular hemorrhage; 6) whether in the hypothetical presence of a negative CT angiogram they would still recommend CA. An automatic NAPSAH diagnosis was also generated by combining responses to questions 2-5. Reliability was estimated using Gwet's AC1 (κG), and the relationship between the NCCT diagnosis of NAPSAH and the recommendation to perform CA using Cramer's V test. Multi-rater accuracy of NCCT in predicting negative CA was explored. RESULTS Inter-rater reliability for the presence of NAPSAH was moderate (κG = 0.58; 95%CI: 0.47, 0.69), but improved to substantial when automatically generated (κG = 0.70; 95%CI: 0.59, 0.81). The most reliable criteria were the absence of AIF filling (κG = 0.79) and extension to LSF (κG = 0.79). Mean intra-rater reliability was substantial (κG = 0.65). NAPSAH weakly correlated with CA decision (V = 0.50). Mean sensitivity and specificity were 58% (95%CI: 44%, 71%) and 83 % (95%CI: 72 %, 94%), respectively. CONCLUSION NAPSAH remains a diagnosis of exclusion. The NCCT diagnosis was moderately reliable and its impact on clinical decisions modest.
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Affiliation(s)
- Anass Benomar
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. https://twitter.com/AnassBenomarMD
| | - Jose Danilo B Diestro
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, ON, Canada. https://twitter.com/DanniDiestro
| | - Houssam Darabid
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Karim Saydy
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Lora Tzaneva
- Department of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Jimmy Li
- Division of Neurology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada. https://twitter.com/neuroloJimmy
| | - Eleyine Zarour
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. https://twitter.com/eleyine
| | - William Tanguay
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Nohad El Sayed
- Department of Radiology, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Igor Gomes Padilha
- Division of Neuroradiology, Diagnósticos da América SA - DASA, São Paulo, SP, Brazil; Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil; Division of Neuroradiology, United Health Group, São Paulo, SP, Brazil
| | - Laurent Létourneau-Guillon
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. https://twitter.com/LaurentLetG
| | - Céline Bard
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Kristoff Nelson
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Alain Weill
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Daniel Roy
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Johanna Eneling
- Department of Neurosurgery, Linköping University Hospital, Linköping, Sweden
| | - William Boisseau
- Department of Interventional Neuroradiology, Fondation Adolphe de Rothschild, Paris, France
| | - Thanh N Nguyen
- Department of Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, MA, USA. https://twitter.com/NguyenThanhMD
| | - Mohamad Abdalkader
- Department of Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, MA, USA. https://twitter.com/AbdalkaderMD
| | - Ahmed A Najjar
- Division of Neurosurgery, Department of Surgery, College of Medicine, Taibah University, Medina, Saudi Arabia. https://twitter.com/AhmedANajjar
| | - Ahmad Nehme
- Université Caen-Normandie, Neurology, CHU Caen-Normandie, Caen, France. https://twitter.com/ANehme
| | - Émile Lemoine
- Division of Neurology, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. https://twitter.com/lemoineemile
| | - Gregory Jacquin
- Division of Neurology, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - David Bergeron
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. https://twitter.com/David__Bergeron
| | - Tristan Brunette-Clément
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. https://twitter.com/BrunetteClement
| | - Chiraz Chaalala
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Michel W Bojanowski
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Moujahed Labidi
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Roland Jabre
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Katrina H D Ignacio
- Calgary Stroke Program, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada. https://twitter.com/Katha_MD
| | - Abdelsimar T Omar
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Division of Neurosurgery, McMaster University, Hamilton, ON, Canada. https://twitter.com/atomar_md
| | - David Volders
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Adam A Dmytriw
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, ON, Canada; Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. https://twitter.com/AdamDmytriw
| | - Jean-François Hak
- Department of Medical Imaging, University Hospital Timone APHM, Marseille, France. https://twitter.com/JFHak
| | - Géraud Forestier
- Department of neuroradiology, University Hospital of Limoges, Limoges, France. https://twitter.com/GeraudForestier
| | - Quentin Holay
- Department of Radiology, Sainte-Anne Military Hospital, Toulon, France
| | - Richard Olatunji
- Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Nigeria. https://twitter.com/RICHARDOlat
| | - Ibrahim Alhabli
- Calgary Stroke Program, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada. https://twitter.com/ialhabli
| | - Lorena Nico
- Department of Neuroradiology, University Hospital Of Padova, Padova, Italy
| | - Jai J S Shankar
- Department of Radiology, Health Sciences Centre, Winnipeg, MB, Canada. https://twitter.com/shivajai1
| | - Adrien Guenego
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium. https://twitter.com/GuenegoAdrien
| | - Jose L R Pascual
- Department of Anatomy, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines. https://twitter.com/drbrainhacker
| | - Thomas R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, ON, Canada. https://twitter.com/trmarot
| | - Juan I Errázuriz
- Department of Radiology, McGill University Health Centre (MUHC), Montreal, QC, Canada
| | - Amy W Lin
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Aderaldo Costa Alves
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. https://twitter.com/jr_aderaldo
| | - Robert Fahed
- Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Christine Hawkes
- Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada. https://twitter.com/CMHawkes
| | - Hubert Lee
- Division of Neurosurgery, Trillium Health Partners, Toronto, ON, Canada
| | - Elsa Magro
- Department of Neurosurgery, Hôpital de la Cavale Blanche, CHRU de Brest, Brest, France
| | - Lila Sheikhi
- Department of Neurology, University of Kentucky, Lexington, KY, USA. https://twitter.com/lila_sheikhi
| | - Tim E Darsaut
- Department of Surgery, Division of Neurosurgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, AB, Canada. https://twitter.com/tdarsaut
| | - Jean Raymond
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
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