Skip to main content

Advertisement

SpringerLink
Log in

Intra- and inter-observer variability in intracranial aneurysm segmentation: comparison between CT angiography (semi-automated segmentation software stroke VCAR) and digital subtraction angiography (3D rotational angiography)

  • Vascular and Interventional Radiology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

To compare size and morphologic features of three-dimensional aneurysm models, obtained with a semi-automated segmentation software (Stroke VCAR, GE, USA) from cerebral CT angiography (CTA) data, to three-dimensional aneurysm models obtained with digital subtraction angiography (DSA, with 3D rotational angiography acquisition—3DRA), considered as the reference standard.

Methods

In this retrospective study, we reviewed 132 patients, with a total number of 137 intracranial aneurysm, who underwent CTA and subsequent DSA examination, supplemented with 3DRA. We compared neck length, short axis and long axis measured on 3DRA model to the same variables measured on 3D-CTA model by two blinded readers and to the automatic software dimensions. Therefore, statistics analysis assessed intra-observer and inter-observer variability and differences between patients with or without subarachnoid hemorrhage (SAH).

Results

There were no significant differences in short-axis and long-axis measurements between 3D angiographic and 3D-CTA models, while comparison of neck lengths revealed a statistically significant difference, which tended to be greater for smaller neck lengths (partial volume effect and “kissing vessels” artifact). There were significant differences between manual and automatic data measured for the same three variables, and the presence of SAH did not affect aneurysm 3D reconstruction. Inter-observer agreement resulted moderate for neck length and substantial for short axis and long axis.

Conclusion

The examined 3D-CTA segmentation system is a reproducible procedure for aneurysm morphologic characterization and, in particular, for assessment of aneurysm sac dimensions, but considerable carefulness is required in neck length interpretation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Qureshi AI, Suri MFK, Nasar A et al (2005) Trends in hospitalization and mortality for subarachnoid hemorrhage and unruptured aneurysms in the United States. Neurosurgery 57:1–7. https://doi.org/10.1227/01.NEU.0000163081.55025.CD

    Article  PubMed  Google Scholar 

  2. Brisman JL, Song JK, Newell DW (2006) Cerebral aneurysms. N Engl J Med 355:928–939. https://doi.org/10.1056/NEJMra052760

    Article  CAS  PubMed  Google Scholar 

  3. Connolly ES, Rabinstein AA, Carhuapoma JR et al (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke 43:1711–1737. https://doi.org/10.1161/STR.0b013e3182587839

    Article  PubMed  Google Scholar 

  4. Lubicz B, Levivier M, François O et al (2007) Sixty-four-row multisection CT angiography for detection and evaluation of ruptured intracranial aneurysms: interobserver and intertechnique reproducibility. Am J Neuroradiol 28:1949–1955. https://doi.org/10.3174/ajnr.A0699

    Article  CAS  PubMed  Google Scholar 

  5. Tomandl BF, Köstner NC, Schempershofe M et al (2004) CT angiography of intracranial aneurysms: a focus on postprocessing. RadioGraphics 24:637–655. https://doi.org/10.1148/rg.243035126

    Article  PubMed  Google Scholar 

  6. Turan N, Heider RAJ, Zaharieva D et al (2016) Sex differences in the formation of intracranial aneurysms and incidence and outcome of subarachnoid hemorrhage: review of experimental and human studies. Transl Stroke Res 7:12–19. https://doi.org/10.1007/s12975-015-0434-6

    Article  PubMed  Google Scholar 

  7. van Gijn J, Kerr RS, Rinkel GJ (2007) Subarachnoid haemorrhage. Lancet 369:306–318

    Article  Google Scholar 

  8. Larsen CC, Astrup J (2013) Rebleeding after aneurysmal subarachnoid hemorrhage: a literature review. World Neurosurg 79:307–312. https://doi.org/10.1016/j.wneu.2012.06.023

    Article  PubMed  Google Scholar 

  9. Velthuis BK, van Leeuwen MS, Witkamp TD et al (2009) Computerized tomography angiography in patients with subarachnoid hemorrhage: from aneurysm detection to treatment without conventional angiography. J Neurosurg 91:761–767. https://doi.org/10.3171/jns.1999.91.5.0761

    Article  Google Scholar 

  10. Westerlaan HE, van Dijk JMC, Jansen-van der Weide MC et al (2011) Intracranial aneurysms in patients with subarachnoid hemorrhage: CT angiography as a primary examination tool for diagnosis—systematic review and meta-analysis. Radiology 258:134–145. https://doi.org/10.1148/radiol.10092373

    Article  PubMed  Google Scholar 

  11. Guo Y, Wang H, Chen C et al (2012) 320-Detector row CT angiography for detection and evaluation of intracranial aneurysms: comparison with conventional digital subtraction angiography. Clin Radiol 68:e15–e20. https://doi.org/10.1016/j.crad.2012.09.001

    Article  PubMed  Google Scholar 

  12. Stroke VCAR—GE Healthcare. https://www.gehealthcare.com/en/products/advanced-visualization/all-applications/stroke-vcar

  13. González-Darder JM, Pesudo-MartÍnez JV, Feliu-Tatay RA (2001) Microsurgical management of cerebral aneurysms based in CT angiography with three-dimensional reconstruction (3D-CTA) and without preoperative cerebral angiography. Acta Neurochir (Wien) 143:673–679. https://doi.org/10.1007/s007010170045

    Article  Google Scholar 

  14. Goertz L, Hamisch C, Kabbasch C et al (2019) Impact of aneurysm shape and neck configuration on cerebral infarction during microsurgical clipping of intracranial aneurysms. J Neurosurg. https://doi.org/10.3171/2019.1.JNS183193

    Article  Google Scholar 

  15. Matsumoto et al-2007-Fukushima J Med Sci.pdf

  16. Pedicelli A, Desiderio F, Esposito G et al (2012) Three-dimensional rotational angiography for craniotomy planning and postintervention evaluation of intracranial aneurysmsUtilizzo dell’angiografia rotazionale 3D per la strategia d’approccio chirurgico craniotomico e nel controllo post-operatorio degli a. Radiol Med 118:415–430. https://doi.org/10.1007/s11547-012-0869-8

    Article  PubMed  Google Scholar 

  17. Zhang H, Hou C, Zhou Z et al (2014) Evaluating of small intracranial aneurysms by 64-detector CT angiography: a comparison with 3-dimensional rotation DSA or surgical findings. J Neuroimaging 24:137–143. https://doi.org/10.1111/j.1552-6569.2012.00747.x

    Article  PubMed  Google Scholar 

  18. Luo Z, Wang D, Sun X et al (2012) Comparison of the accuracy of subtraction CT angiography performed on 320-detector row volume CT with conventional CT angiography for diagnosis of intracranial aneurysms. Eur J Radiol 81:118–122. https://doi.org/10.1016/j.ejrad.2011.05.003

    Article  PubMed  Google Scholar 

  19. Chen W, Xing W, He Z et al (2016) Accuracy of 320-detector row nonsubtracted and subtracted volume CT angiography in evaluating small cerebral aneurysms. J Neurosurg 127:725–731. https://doi.org/10.3171/2016.8.jns16238

    Article  PubMed  Google Scholar 

  20. Geers AJ, Larrabide I, Radaelli AG et al (2011) Patient-specific computational hemodynamics of intracranial aneurysms from 3D rotational angiography and CT angiography: an in vivo reproducibility study. Am J Neuroradiol 32:581–586. https://doi.org/10.3174/ajnr.A2306

    Article  CAS  PubMed  Google Scholar 

  21. Piotin M, Gailloud P, Bidaut L et al (2003) CT angiography, MR angiography and rotational digital subtraction angiography for volumetric assessment of intracranial aneurysms. An experimental study. Neuroradiology 45:404–409. https://doi.org/10.1007/s00234-002-0922-8

    Article  CAS  PubMed  Google Scholar 

  22. Schneiders Marquering HA, Antiga L, van den Berg R, VanBavel E, Majoie CBJJ (2012) Intracranial aneurysm neck size overestimation with 3D rotational angiography: an exploratory study on the impact on intra-aneurysmal hemodynamics simulated with CFD. AJNR Am J Neuroradiol 34:121–128

    Article  Google Scholar 

  23. Behme D, Amelung N, Khakzad T, Psychogios MN (2018) How to size intracranial aneurysms: a phantom study of invasive and noninvasive methods. Am J Neuroradiol 39:2291–2296. https://doi.org/10.3174/ajnr.A5866

    Article  CAS  PubMed  Google Scholar 

  24. Bederson JB, Connolly ES, Batjer HH et al (2009) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the stroke council, American heart association. Stroke 40:994–1025. https://doi.org/10.1161/STROKEAHA.108.191395

    Article  PubMed  Google Scholar 

  25. Awad AJ, Mascitelli JR, Haroun RR et al (2017) Endovascular management of fusiform aneurysms in the posterior circulation: the era of flow diversion. Neurosurg Focus 42:1–7. https://doi.org/10.3171/2017.3.FOCUS1748

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. UOC Radiologia e Neuroradiologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    F. D’Argento, A. Pedicelli, C. Ciardi, E. Leone, A. Infante, A. Alexandre, E. Lozupone, I. Valente & C. Colosimo

  2. Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy

    M. Scarabello

  3. Instituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy

    C. Colosimo

Authors
  1. F. D’Argento
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Pedicelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Ciardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Leone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Scarabello
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Infante
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Alexandre
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. E. Lozupone
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. I. Valente
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. C. Colosimo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. D’Argento.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

D’Argento, F., Pedicelli, A., Ciardi, C. et al. Intra- and inter-observer variability in intracranial aneurysm segmentation: comparison between CT angiography (semi-automated segmentation software stroke VCAR) and digital subtraction angiography (3D rotational angiography). Radiol med 126, 484–493 (2021). https://doi.org/10.1007/s11547-020-01275-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-020-01275-y

Keywords

Search

Navigation