Interobserver reliability of computed tomography angiography in the assessment of ruptured intracranial aneurysm and impact on patient management

BACKGROUND Aneurysmal subarachnoid hemorrhage is an emergency that can lead to a high mortality rate and many severe complications.It is critical to make a rapid radiological evaluation of ruptured intracranial aneurysms(RIAs)to determine the appropriate surgical treatment.AIM To assess the reliability of computed tomography angiography(CTA)in assessing different features of ruptured intracranial aneurysm and its impact on patient management.METHODS The final cohort of this study consisted of 146 patients with RIAs(75 male and 71 female)who underwent cerebral CTA.Their age ranged from 25 to 80,and the mean age±SD was 57±8.95 years.Two readers were asked to assess different features related to the aneurysm and perianeurysmal environment.Inter-observer agreement was measured using kappa statistics.Imaging data extracted from non-contrast computed tomography and CTA were considered to categorize the study population into two groups according to the recommended therapeutic approach.RESULTS The inter-observer agreement of both reviewers was excellent for the detection of aneurysms(K=0.95,P=0.001),aneurysm location(K=0.98,P=0.001),and(K=0.98,P=0.001),morphology(K=0.92,P=0.001)and margins(K=0.95,P=0.001).There was an excellent interobserver agreement for the measurement of aneurysm size(K=0.89,P=0.001),neck(K=0.85,P=0.001),and dome-to-neck ratio(K=0.98,P=0.001).There was an excellent inter-observer agreement for the detection of other aneurysm-related features such as thrombosis(K=0.82,P=0.001),calcification(K=1.0,P=0.001),bony landmark(K=0.89,P=0.001)and branch incorporation(K=0.91,P=0.001)as well as perianeurysmal findings including vasospasm(K=0.91,P=0.001),perianeurysmal cyst(K=1.0,P=0.001)and associated vascular lesions(K=0.83,P=0.001).Based on imaging features,87 patients were recommended to have endovascular treatment,while surgery was recommended in 59 patients.71.2%of the study population underwent the recommended therapy.CONCLUSION CTA is a reproducible promising diagnostic imaging modality for detecting and characterizing cerebral aneurysms.

Outcome of percutaneous drainage for septic complications coexisted with COVID-19

BACKGROUND The resulting tissue hypoxia and increased inflammation secondary to severe coronavirus disease 2019(COVID-19)combined with viral load,and other baseline risk factors contribute to an increased risk of severe sepsis or co-existed septic condition exaggeration.AIM To describe the clinical,radiological,and laboratory characteristics of a small cohort of patients infected by severe acute respiratory syndrome coronavirus 2 who underwent percutaneous drainage for septic complications and their postprocedural outcomes.METHODS This retrospective study consisted of 11 patients who were confirmed to have COVID-19 by RT-PCR test and required drain placement for septic complications.The mean age±SD of the patients was 48.5±14 years(range 30-72 years).Three patients underwent cholecystostomy for acute acalculous cholecystitis.Percutaneous drainage was performed in seven patients;two peripancreatic collections;two infected leaks after hepatic resection;one recurrent hepatic abscess,one psoas abscess and one lumbar abscess.One patient underwent a percutaneous nephrostomy for acute pyelonephritis.RESULTS Technical success was achieved in 100%of patients,while clinical success was achieved in 4 out of 11 patients(36.3%).Six patients(54.5%)died despite proper percutaneous drainage and adequate antibiotic coverage.One patient(9%)needed operative intervention.Two patients(18.2%)had two drainage procedures to drain multiple fluid collections.Two patients(18.2%)had repeat drainage procedures due to recurrent fluid collections.The average volume of the drained fluid immediately after tube insertion was 85 mL.Follow-up scans show a reduction of the retained content and associated inflammatory changes after tube insertion in all patients.There was no significant statistical difference(P=0.6 and 0.4)between the mean of WBCs and neutrophils count before drainage and seven days after drainage.The lymphocyte count shows significant increased seven days after drainage(P=0.03).CONCLUSION In this study,patients having septic complications associated with COVID-19 showed relatively poor clinical outcomes despite technically successful percutaneous drainage.