Background: Intracranial aneurysm affect 3-7% of the global population, with rupture causing > 80% of non-traumatic subarachnoid hemorrhage and approximately 50% mortality. Clinical management relies on precise measurement of aneurysm neck width and maximum length, where ≥ 1 mm growth signals elevated rupture risk. computed tomography angiography enables non-invasive monitoring but manual measurements suffer from inter-observer variability. Commercial artificial intelligence platforms offer potential improvements, yet their consistency and accuracy versus digital subtraction angiography, the gold standard, are understudied.
Methods: This retrospective study analyzed 148 patients with 163 Intracranial aneurysms via computed tomography angiography, including a subgroup of 86 with digital subtraction angiography within 1 week. Measurements were obtained using Shukun artificial intelligence, UIH artificial intelligence, manual computed tomography angiography (intra-observer repeated at 1 month), and digital subtraction angiography. Reproducibility was assessed by coefficient of variation; agreement by Bland-Altman analysis, with 95% limits of agreement within ± 1.0 mm considered clinically acceptable.
Results: Results For aneurysm neck width, manual measurements had a mean difference of -1.62 mm and 95% limits of agreement of -4.87 to 1.62 mm vs. digital subtraction angiography, while UIH artificial intelligence and Shukun artificial intelligence had mean differences of + 0.80 mm and - 1.01 mm, and 95% limits of agreement of -3.68 to 2.08 mm and - 3.06 to 1.04 mm, respectively. For aneurysm maximum length, UIH artificial intelligence systematically overestimated (mean difference: +3.46 mm) and Shukun artificial intelligence underestimated (mean difference: -2.20 mm) vs. digital subtraction angiography. Both artificial intelligence platforms had narrower coefficients of variation (0.31-0.36 for aneurysm neck width, 0.23-0.26 for aneurysm maximum length) than manual measurements (0.36-0.42, 0.23-0.24). However, all methods exceeded the clinically acceptable ± 1.0 mm threshold.
Conclusions: Artificial intelligence platforms have better reproducibility than manual measurements but show systematic biases, not meeting the clinical ± 1.0 mm precision vs. the digital subtraction angiography gold standard. Inter-platform variability exceeds the aneurysm growth threshold, requiring consistent use of the same artificial intelligence platform in serial surveillance to prevent misinterpreting changes.
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