Nonaneurysmal perimesencephalic subarachnoid hemorrhage on noncontrast head CT: an accuracy, inter-rater, and intra-rater reliability study - 20/02/24

Doi : 10.1016/j.neurad.2024.02.002

Anass Benomar ¹ , Jose D.B. Diestro ² , Houssam Darabid ¹ , Karim Saydy ¹ , Lora Tzaneva ³ , Jimmy Li ⁴ , Eleyine Zarour ¹ , William Tanguay ¹ , Nohad El Sayed ⁵ , Igor Gomes Padilha ^6,^7,⁸ , Laurent Létourneau-Guillon ¹ , Céline Bard ¹ , Kristoff Nelson ¹ , Alain Weill ¹ , Daniel Roy ¹ , Johanna Eneling ⁹ , William Boisseau ¹⁰ , Thanh N. Nguyen ¹¹ , Mohamad Abdalkader ¹¹ , Ahmed A. Najjar ¹² , Ahmad Nehme ¹³ , Émile LemoineA ¹⁴ , Gregory Jacquin ¹⁴ , David Bergeron ¹⁵ , Tristan Brunette-Clément ¹⁵ , Chiraz Chaalala ¹⁵ , Michel W. Bojanowski ¹⁵ , Moujahed Labidi ¹⁵ , Roland Jabre ¹⁵ , Katrina H.D. Ignacio ¹⁶ , Abdelsimar T. Omar ^17,¹⁸ , David Volders ¹⁹ , Adam A. Dmytriw ^2,²⁰ , Jean-François Hak ²¹ , Géraud Forestier ²² , Quentin Holay ²³ , Richard Olatunji ²⁴ , Ibrahim Alhabli ¹⁶ , Lorena Nico ²⁵ , Jai J.S. Shankar ²⁶ , Adrien Guenego ²⁷ , Jose L.R. Pascual ²⁸ , Thomas R. Marotta ² , Juan I. Errázuriz ⁵ , Amy W. Lin ² , Aderaldo Costa Alves ²⁹ , Robert Fahed ³⁰ , Christine Hawkes ³¹ , Hubert Lee ³² , Elsa Magro ³³ , Lila Sheikhi ³⁴ , Tim E. Darsaut ³⁵ , Jean Raymond ^1,^⁎
on behalf of
RSND (Reliability Studies for Neurovascular Diseases) collaborators
¹ Department of Radiology, Radiation Oncology and Nuclear Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
² Division of Diagnostic and Therapeutic Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, ON, Canada
³ Department of Experimental Surgery, McGill University, Montreal, QC, Canada
⁴ Division of Neurology, Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
⁵ Department of Radiology, McGill University Health Centre (MUHC), Montreal, QC, Canada
⁶ Division of Neuroradiology, Diagnósticos da América SA – DASA, São Paulo, SP, Brazil
⁷ Division of Neuroradiology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil
⁸ Division of Neuroradiology, United Health Group, São Paulo, SP, Brazil
⁹ Department of Neurosurgery, Linköping University Hospital, Linköping, Sweden
¹⁰ Department of Interventional Neuroradiology, Fondation Adolphe de Rothschild, Paris, France
¹¹ Department of Neurology, Neurosurgery, and Radiology, Boston Medical Center, Boston, MA, USA
¹² Division of Neurosurgery, Department of Surgery, College of Medicine, Taibah University, Medina, Saudi Arabia
¹³ Université Caen-Normandie, Neurology, CHU Caen-Normandie, Caen, France
¹⁴ Division of Neurology, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
¹⁵ Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
¹⁶ Calgary Stroke Program, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
¹⁷ Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
¹⁸ Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
¹⁹ Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
²⁰ Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
²¹ Department of Medical Imaging, University Hospital Timone APHM, Marseille, France
²² Department of neuroradiology, University Hospital of Limoges, Limoges, France
²³ Department of Radiology, Sainte-Anne Military Hospital, Toulon, France
²⁴ Department of Radiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
²⁵ Department of Neuroradiology, University Hospital Of Padova, Padova, Italy
²⁶ Department of Radiology, Health Sciences Centre, Winnipeg, MB, Canada
²⁷ Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
²⁸ Department of Anatomy, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
²⁹ Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
³⁰ Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
³¹ Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
³² Division of Neurosurgery, Trillium Health Partners, Toronto, ON, Canada
³³ Department of Neurosurgery, Hôpital de la Cavale Blanche, CHRU de Brest, Brest, France
³⁴ Department of Neurology, University of Kentucky, Lexington, KY, USA
³⁵ Department of Surgery, Division of Neurosurgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, AB, Canada

^⁎Corresponding Author: Dr. Jean Raymond. Centre hospitalier de l'Université de Montréal (CHUM), Department of Radiology, room D03.5462b, 1000 Saint-Denis st, Montreal, Quebec, CANADA H2X0C1. Tel.: +1 (438) 938-5122. Fax: +1 (514) 412-7489.Centre hospitalier de l'Université de Montréal (CHUM), Department of Radiology, room D03.5462b1000 Saint-Denis stMontrealQuebecH2X0C1CANADA

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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 (κ_G), 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 (κ_G=0.58; 95%CI: 0.47,0.69), but improved to substantial when automatically generated (κ_G=0.70; 95%CI: 0.59,0.81). The most reliable criteria were the absence of AIF filling (κ_G=0.79) and extension to LSF (κ_G=0.79). Mean intra-rater reliability was substantial (κ_G=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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Keywords : Nonaneurysmal perimesencephalic subarachnoid hemorrhage, Noncontrast Head CT, Catheter Angiography, Inter-rater reliability, Multi-rater multi-case accuracy

Abbreviations : AIF, CA, CTA, IVH, LSF, NAPSAH, NCCT