Observer Variation in Cerebral Angiography: An Assessment of the Value of Minor Angiographic Changes in the Radiological Diagnosis of Cerebrovascular Disease

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Abstract
An evaluation of the usefulness in the diagnosis of cerebrovascular disease of certain criteria in cerebral angiograms from which gross abnormalities were absent, has been conducted according to a careful design. This involved the "blind" comparison by 3 observers at 2 readings of a series of angiograms from patients with acute cerebrovascular accidents with a series from patients with no clinical evidence of cerebrovascular disease. Irregularity of the walls of cerebral vessels and variation in their calibre were shown to be of diagnostic value, whilst tortuosity of cerebral vessels and abnormalities in the configuration of the bifurcation of the internal carotid into middle and anterior cerebral arteries (the "T-junction") were found to be of no value. The magnitude of inter- and intra-observer variation, which has been shown to occur in the detection of minor abnormalities, demonstrates the necessity for such a study, whenever the validity of diagnostic criteria is in doubt.

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