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In Part I of this study, articles reporting the reliability of CTA up to May 2018 were systematically searched and evaluated. In Part II, 11 raters independently graded 17 arterial segments in each of 50 patients with SAH for the presence of vasospasm using a 4-category scale. Raters were additionally asked to judge the presence of any moderate/severe vasospasm and whether findings would justify augmentation of medical treatment or conventional angiography ± balloon angioplasty. The systematic review revealed few studies with heterogeneous vasospasm definitions. In Part II, the authors found interrater reliability to be moderate at best (ϰ > 0.6), even when results were stratified according to specialty and experience. They conclude that the diagnosis of vasospasm using CTA alone was not sufficiently repeatable among observers to support its general use to guide decisions in the clinical management of patients with SAH.