Reliability of dual- vs single-volume reconstruction of three-dimensional digital subtraction angiography for follow-up evaluation of endovascularly treated intracranial aneurysms

Introduction: Single-volume reconstruction of three-dimensional (3D) digital subtraction angiography (DSA) can be effectively used for aneurysm assessment and planning of endovascular embolization. Unfortunately, post-embolization follow-up angiographic images can be obscured by artifact. The dual-volume reconstruction technique was developed in order to reduce artifact and enhance the visualization of the aneurysm, the parent vessel and side branches, and endovascular devices. The purpose of this study was to compare the reliability of dual-vs single-volume reconstruction of 3D DSA in evaluation of follow-up images after endovascular embolization of intracranial aneurysms. Method: Four cerebrovascular neurosurgeons independently and blindly reviewed 20 randomly selected dual-and single-volume reconstructions of 3D DSAs demonstrating cerebral aneurysms treated with primary coil embolization, stent-assisted coil embolization, or Pipeline embolization. Five images were repeated for each modality (single and dual volume) in order to assess intra-rater reliability. The intraclass correlation coefficient was calculated as a measure of the overall inter-rater agreement. Cohen's kappa value was used to assess repeat measurement consistency for each rater. Results: Overall inter-rater agreement using dual-and single-volume reconstruction was 0.81 and 0.75, respectively. Dual-volume reconstruction resulted in superior agreement in assessing location, occlusion status, position of aneurysm recanalization or residual, status of nearby branches, presence of coil migration and presence of intravascular devices (stent or Pipeline). Conclusion: Three-dimensional reconstruction is an important complementary imaging technique in evaluating the angioarchitecture of aneurysms and recanalization after endovascular embolization. Dual-volume reconstruction imaging was associated with superior inter-and intra-rater reliability.