This study (IEDAL study) intends to prospectively enroll more than 6450 patients who will undergo head CT angiography (CTA) scanning in the outpatient clinic. It will be carried out in 21 hospitals in more than 10 provinces in China. The patient's head CTA images will be randomly assigned to the True-AI and Sham-AI group with a ratio of 1:1, and the patients and radiologists are unaware of the allocation. The primary outcomes are sensitivity and specificity of detecting intracranial aneurysms. The secondary outcomes focus on the prognosis and outcomes of the patients.
A multicenter, prospective, double-blind, randomized controlled trial will be conducted (IDEAL study). Patients who are scheduled to undergo cranial CT angiography (CTA) scanning will be randomly divided into two groups with a ratio of 1:1, one of the group will be assigned to True-AI aided intracranial aneurysms diagnosis strategy (True-AI group) and the other will be assigned to Sham-AI aided intracranial aneurysms diagnosis strategy (Sham-AI group, which has a sensitivity close to 0% and a similar specificity to True-AI). The primary outcomes are diagnostic sensitivity and specificity of detecting aneurysms. Secondary endpoints include other diagnostic performance indexes for intracranial aneurysms; diagnostic performances for other intracranial lesions for intracranial arterial stenosis, occlusion, and intracranial tumors; detection rates of intracranial lesions according to Radiology Reports; workload of head CTA interpretation; resource use; treatment-related indexes during patient follow-up (e.g. clinical follow-up, hospitalization, rate of patients undergoing DSA); life quality; outcomes of aneurysm-related events; repeat head CTA or MRA at 12-month follow; cost-effectiveness analysis between intervention and control arm to evaluate the short- and longterm influence of AI system to the routine practice and patients' prognosis and outcomes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
DIAGNOSTIC
Masking
QUADRUPLE
Enrollment
6,450
The True-AI deep-learning based model for intracranial aneurysms detection had a patient-wise sensitivity, lesion-wise sensitivity and specificity of 0.96, 0.87, and 0.80 in the internal validation dataset.
The Sham-AI deep-learning based model for intracranial aneurysms detection is designed to have a sensitivity close to 0% and a similar specificity to the True-AI. In the internal validation dataset, the Sham-AI had a patient-wise sensitivity, lesion-wise sensitivity, specificity of 0.02, 0.01, and 0.80, respectively.
The First Affiliated Hospital of University of Science and Technology of China
Hefei, Anhui, China
RECRUITINGThe First Affiliated Hospital of Wannan Medical College
Wuhu, Anhui, China
RECRUITINGGuizhou Provincial People's Hospital
Guiyang, Guizhou, China
RECRUITINGFirst Affiliated Hospital of Zhengzhou University
Zhengzhou, Henan, China
RECRUITINGShiyan People's Hospital
Shiyan, Hubei, China
RECRUITINGResearch Institute Of Medical Imaging Jinling Hospital
Nanjing, Jiangsu, China
RECRUITINGAffiliated Hospital of Xuzhou Medical University
Xuzhou, Jiangsu, China
RECRUITINGThe First Hospital of Jilin University
Changchun, Jilin, China
RECRUITINGShandong Provincial Hospital Affiliated to Shandong First Medical University
Jinan, Shandong, China
RECRUITINGYidu Central Hospital Affiliated to Shandong Second Medical University
Weifang, Shandong, China
RECRUITING...and 11 more locations
To compare diagnostic sensitivity of intracrnial aneurysms between intervention and control arm.
The proportion of examinations in which at least one aneurysm is discovered and indicated among groundtruth aneurysms.
Time frame: 6 months.
To compare diagnostic specificity of intracrnial aneurysms between intervention and control arm.
The proportion of examinations in which no aneurysms are spotted by the reader among groundtruth non-aneurysms.
Time frame: 6 months.
To compare other diagnostic performances for intracranial aneurysms between intervention and control arm.
To compare accuracy, lesion-wise sensitivity, positive predictive value and negative predictive value for intracranial aneurysms between intervention and control arm.
Time frame: 6 months.
To compare diagnostic performances for other intracranial lesions between intervention and control arm.
The sensitivity, specificity, accuracy, positive predictive value and negative predictive value for intracranial arterial stenosis, occlusion, and intracranial tumors are compared between intervention and control arm.
Time frame: 6 months.
To compare detection rates of intracranial lesions according to Radiology Reports between intervention and control arm.
Detection rates of intracranial aneurysms, intracranial arterial stenosis, occlusion, and intracranial tumors according to Radiology Reports are compared between intervention and control arm.
Time frame: 6 months.
To assess the workload of head CT angiography interpretation.
Time of interpreting head CT angiography images, number of consensus meeting are compared between intervention and control arm.
Time frame: 6 months.
To assess resource use.
The number of care encounters (in-person) during follow-up, total number of outpatient encounters for aneurysm referral, total number of cerebral artery disease testing are compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Rate of patients of subsequent hospitalization during patient follow-up.
Rate of patients of subsequent hospitalization is compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
In-hospital mortality rate during patient follow-up.
In-hospital mortality rate is compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Morbidity (modified Rankin Score ≥ 3) from intracranial haemorrhage or treatment during patient follow-up.
Morbidity (modified Rankin Score ≥ 3) from intracranial haemorrhage or treatment is compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Length of hospital stay during patient follow-up.
Length of hospital stay is compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Rate of hospitalization for intracranial aneurysms during patient follow-up.
Rate of hospitalization for intracranial aneurysms is compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Rate of patients undergoing digital subtraction angiography (DSA) during patient follow-up.
Rate of patients undergoing digital subtraction angiography (DSA) is compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Detection rate of intracranial aneurysms among digital subtraction angiographys (DSA) during patient follow-up.
Detection rate of intracranial aneurysms among digital subtraction angiographys (DSA) is compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Detection rate of no abnormality among digital subtraction angiographys (DSA) during patient follow-up.
Detection rate of no abnormality among digital subtraction angiographys (DSA) is compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Distribution of the methods for aneurysms management (conservative/coil/clip/others) during patient follow-up.
Distribution of the methods for aneurysms management (conservative/coil/clip/others) is compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Rates of aneurysm treatment related complications during patient follow-up.
Rate of aneurysm treatment related complications (intraoperative rupture, stroke, et al) is compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Rate of recurrence or residual of intracranial aneurysm after surgery during patient follow-up.
Rate of recurrence or residual of intracranial aneurysm after surgery is compared between intervention and control arm.
Time frame: At 12-month follow-up.
Life quality assessed by EuroQol 5-Dimensional, 5-Level (EQ-5D-5L) during patient follow-up.
Life quality assessed by EuroQol 5-Dimensional, 5-Level (EQ-5D-5L) scores are compared between intervention and control arm, which ranges from 5 to 25, and higher scores mean a worse outcome.
Time frame: At 3-month and 12-month follow-up.
Restrictions in daily activities assessed by Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) scores during patient follow-up.
Restrictions in daily activities assessed by Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) scores are compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Sleep quality assessed by Pittsburgh Sleep Quality Index (PSQI) during patient follow-up.
Sleep quality assessed by Pittsburgh Sleep Quality Index (PSQI) is compared between intervention and control arm, which ranges from 0 to 21, and higher scores mean a worse outcome.
Time frame: At 3-month and 12-month follow-up.
Depression Screening assessed by Patient Health Questionnaire-9 (PHQ-9) scores during patient follow-up.
Depression Screening assessed by Patient Health Questionnaire-9 (PHQ-9) scores are compared between intervention and control arm, which ranges from 0 to 27, and higher scores mean a worse outcome.
Time frame: At 3-month and 12-month follow-up.
Anxiety and depression assessed by Hospital Anxiety and Depression Scale (HADS) scores during patient follow-up.
Anxiety and depression assessed by Hospital Anxiety and Depression Scale (HADS) scores are compared between intervention and control arm, which ranges from 0 to 21, and higher scores mean a worse outcome.
Time frame: At 3-month and 12-month follow-up.
General health assessed by Short-Form 36 Health Survey (SF-36) scores during patient follow-up.
General health assessed by Short-Form 36 Health Survey (SF-36) scores are compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Functional outcome assessed by Modified Rankin Scale (mRS) scores during patient follow-up.
Functional outcome assessed by Modified Rankin Scale (mRS) scores are compared between intervention and control arm, which ranges from 0 to 5, and higher scores mean a worse outcome.
Time frame: At 3-month and 12-month follow-up.
All-cause mortality during patient follow-up.
All-cause mortality is compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Rate of aneurysm growth during patient follow-up.
Rate of aneurysm growth is compared between intervention and control arm.
Time frame: At 12-month follow-up.
Rate of aneurysm rupture during patient follow-up.
Rate of aneurysm rupture is compared between intervention and control arm.
Time frame: At 12-month follow-up.
Rate of subarachnoid hemorrhage (SAH) during patient follow-up.
Rate of subarachnoid hemorrhage (SAH) is compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Rate of other types of stroke (hemorrhagic stroke, ischemic stroke) during patient follow-up.
Rate of other types of stroke (hemorrhagic stroke, ischemic stroke) is compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Mortality of aneurysms-rupture during patient follow-up.
Mortality of aneurysms-rupture is compared between intervention and control arm.
Time frame: At 3-month and 12-month follow-up.
Morphological change by head CTA or magnetic resonance angiography at the 12-month follow-up.
Morphological change by head CTA or magnetic resonance angiography is assessed.
Time frame: At 12-month follow-up.
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