A multicenter prospective study using intracranial aneurysm auxiliary assessment software to evaluate the stability of unruptured aneurysms
Objective To explore the effect of using intracranial aneurysm auxiliary assessment software to evaluate the stability of unruptured aneurysms(UIA).Methods UIA patients who visited the Neurosurgery Department of 7 centers including Beijing Tiantan Hospital,Capital Medical University from May to September 2022 were prospectively included.Software-assisted physician assessment,physician independent assessment,the expert group assessment,PHASES score,and ELAPSS score were used to evaluate whether the aneurysms of all patients were stable.Stratified random sampling was used to randomly divide patients into two groups,A and B.Group A was first evaluated by software-assisted doctors,and then independently evaluated by doctors after a 4-week washout period;group B was evaluated in the opposite order.The evaluation results of the expert group were used as the"gold standard"to judge the stability of UIA,and the accuracy,sensitivity and specificity of the aneurysm auxiliary evaluation software and other evaluation methods were compared.The consistency of these methods with"gold standard"were also compared.Subgroup analysis was performed according to the maximum aneurysm diameter.Results A total of 192 patients(227 aneurysms)were included,including 62 males and 130 females;age[M(Q1,Q3)]was 58.0(50.5,65.0)years old.Among the 227 aneurysms,98 were stable and 129 were unstable.The accuracy and sensitivity of software-assisted physician assessment(92.5％and 93.8％)were higher than those of physician independent assessment(76.7％and 85.3％),PHASES score(62.6％and 39.5％)and ELAPSS score(79.3％and 76.7％),the differences were statistically significant(all P＜0.05).The difference between the specificity of software-assisted physician assessment(90.8％)and PHASES score(92.9％)and ELAPSS score(82.7％)was not statistically significant(both P＞0.05),but was higher than that of physician independent assessment(65.3％,P＜0.05).In terms of consistency,compared with the"gold standard",there were no statistically significant differences in the results of software-assisted physician evaluation(Kappa=0.94),physician independent evaluation(Kappa=0.81)and ELAPSS score evaluation(Kappa=0.83)(all P＞0.05),among which the software-assisted physician assessment had the best consistency with the"gold standard";and the difference between the PHASES score and the"gold standard"assessment results was statistically significant(paired x2=45.84,P＜0.001).Subgroup analysis results showed that in the maximum diameter＜3 mm group,3-5 mm group and＞5-7 mm group,the software-assisted physician assessment had high consistency with the"gold standard"(Kappa was 0.94,0.79 and 0.85 respectively)to other assessment methods.There was no statistical significance in the accuracy of software-assisted physician assessment and physician independent assessment between group A and group B(both P＞0.05).Conclusions The intracranial aneurysm auxiliary assessment software can assist neurosurgeons in assessing the stability of UIA.Its accuracy is better than the assessment results of independent assessment by doctors,PHASES score and ELAPSS score,and it is worthy of clinical promotion and application.
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