Intrarater and interrater reliability of the pediatric arteriovenous malformation compactness score in children

Clinical article

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Cerebral arteriovenous malformations (AVMs) have a higher postresection recurrence rate in children than in adults. The authors' previous study demonstrated that a diffuse AVM (low compactness score) predicts postresection recurrence. The aims of this study were to evaluate the intra- and interrater reliability of the AVM compactness score.


Angiograms of 24 patients assigned a preoperative compactness score (scale of 1–3; 1 = most diffuse, 3 = most compact) in the authors' previous study were rerated by the same pediatric neuroradiologist 9 months later. A pediatric neurosurgeon, pediatric neuroradiology fellow, and interventional radiologist blinded to each other's ratings, the original ratings, and AVM recurrence also rated each AVM's compactness. Intrarater and interrater reliability were calculated using the κ statistic.


Of the 24 AVMs, scores by the original neuroradiologist were 1 in 6 patients, 2 in 16 patients, and 3 in 2 patients. Intrarater reliability was 1.0. The κ statistic among the 4 raters was 0.69 (95% CI 0.44–0.89), which indicates substantial reliability. The interrater reliability between the neuroradiologist and neuroradiology fellow was moderate (κ = 0.59 [95%CI 0.20–0.89]) and was substantial between the neuroradiologist and neurosurgeon (κ = 0.74 [95% CI 0.41–1.0]). The neuroradiologist and interventional radiologist had perfect agreement (κ = 1.0).


Intrarater and interrater reliability of the AVM compactness score were excellent and substantial, respectively. These results demonstrate that the AVM compactness score is reproducible. However, the neuroradiologist and interventional radiologist had perfect agreement, which indicates that the compactness score is applied most accurately by those with extensive angiography experience.

Abbreviation used in this paper:AVM = arteriovenous malformation.

Article Information

Address correspondence to: Lauren A. Beslow, M.D., M.S.C.E., Departments of Pediatrics and Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520. email:

Please include this information when citing this paper: published online March 15, 2013; DOI: 10.3171/2013.2.PEDS12465.

© AANS, except where prohibited by US copyright law.



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    Examples of AVM compactness Score 1. A: Lateral cerebral angiogram demonstrating a large diffuse AVM (arrows). B: Lateral cerebral angiogram demonstrating a small but diffuse AVM near the vertex (arrows). The AVM does not have a compact nidus. An early draining vein is seen along its superior margin (uppermost arrow). C: Cerebral angiogram showing a large diffuse AVM. There is a more compact portion of the AVM with a large early draining vein, but there is also a larger yet less compact component of abnormal vascularity with large amounts of intervening brain tissue as well (arrows), which make this a diffuse AVM with a compactness score of 1. D: Lateral cerebral angiogram demonstrating another small but diffuse AVM (arrows). A number of narrow-caliber, small, abnormal vessels are seen in the region of the AVM, without a compact nidus.

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    Cerebral angiogram demonstrating an AVM with a compactness score of 2.

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    Cerebral angiogram demonstrating a highly compact AVM with a compactness score of 3.



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