Non-contrast CT markers of intracerebral hematoma expansion : a reliability study
Article [Accepted Manuscript]
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European radiology ; vol. 32, no. 9, pp. 6126-6135.Publisher(s)
SpringerAuthor(s)
Abstract(s)
Objectives: We evaluated whether clinicians agree in the detection of non-contrast CT markers of
intracerebral hemorrhage (ICH) expansion.
Methods: From our local dataset, we randomly sampled 60 patients diagnosed with spontaneous ICH.
Fifteen physicians and trainees (Stroke Neurology, Interventional and Diagnostic Neuroradiology) were
trained to identify six density (Barras density, black hole, blend, hypodensity, fluid level, swirl) and three
shape (Barras shape, island, satellite) expansion markers, using standardized definitions. Thirteen raters
performed a second assessment. Inter and intra-rater agreement were measured using Gwet’s AC1, with a
coefficient > 0.60 indicating substantial to almost perfect agreement.
Results: Almost perfect inter-rater agreement was observed for the swirl (0.85, 95% CI: 0.78-0.90) and
fluid level (0.84, 95% CI: 0.76-0.90) markers, while the hypodensity (0.67, 95% CI: 0.56-0.76) and blend
(0.62, 95% CI: 0.51-0.71) markers showed substantial agreement. Inter-rater agreement was otherwise
moderate, and comparable between density and shape markers. Inter-rater agreement was lower for the
three markers that require the rater to identify one specific axial slice (Barras density, Barras shape,
island: 0.46, 95% CI: 0.40-0.52 versus others: 0.60, 95% CI: 0.56-0.63). Inter-observer agreement did not
differ when stratified for raters’ experience, hematoma location, volume or anticoagulation status. Intrarater agreement was substantial to almost perfect for all but the black hole marker.
Conclusion: In a large sample of raters with different backgrounds and expertise levels, only four of nine
non-contrast CT markers of ICH expansion showed substantial to almost perfect inter-rater agreement.
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