de Vries Evelien E, Pourier Vanessa E C, van Laarhoven Constance J H C M, Vonken Evert J, van Herwaarden Joost A, de Borst Gert J
Department of Vascular Surgery, University Medical Center Utrecht, Room G04.129, PO Box 85500, 3508 GA, Utrecht, the Netherlands.
Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Neuroradiology. 2019 Feb;61(2):147-153. doi: 10.1007/s00234-018-2112-3. Epub 2018 Oct 18.
Increased arterial tortuosity has been suggested as a predisposing factor for carotid artery dissection, which is an important risk factor for development of extracranial carotid artery aneurysms (ECAA). Prior to comparison with non-ECAA controls, the optimal measurement technique should be defined. This study describes the difference between software packages in terms of reproducibility and absolute outcome of arterial tortuosity measurements in ECAA patients.
CT-angiography analysis was performed on 12 ECAA patients selected from our registry, using four software packages: 3mensio Vascular, TeraRecon, Vital Images, and Aycan OsiriX PRO. The tortuosity index (TI) was calculated from the skull base until the carotid bifurcation and aortic arch, and was defined as the centerline's true length divided by the straight line distance. Intraclass correlation coefficients (ICC) with 95% confidence intervals were calculated to quantify inter- and intra-observer variability within one software package, and differences in measured TI between packages.
Inter-observer agreement was nearly perfect for 3mensio, excellent for Vital Images and OsiriX, and substantial for TeraRecon, with ICC 0.99 (0.96-1.0), 0.90 (0.69-0.97), 0.84 (0.53-0.95), and 0.72 (0.28-0.91), respectively. Intra-observer agreement ranged from ICC 1.0 for 3mensio to 0.91 for TeraRecon. Agreements in TI ranged from ICC 0.99 (0.98-1.0) for 3mensio vs. OsiriX, to 0.95 (0.82-0.98) for 3mensio vs. TeraRecon. Median time needed to complete one round of measurements was highest for OsiriX (p = 0.013).
Carotid artery tortuosity measurements are reproducible and comparable between current commercially available software packages, with high intra-observer agreement. Although the reproducibility differed per software packages, all packages scored an acceptable inter-observer agreement.
动脉迂曲增加被认为是颈动脉夹层的一个易感因素，而颈动脉夹层是颅外颈动脉动脉瘤（ECAA）形成的一个重要危险因素。在与非ECAA对照组进行比较之前，应确定最佳测量技术。本研究描述了软件包在ECAA患者动脉迂曲测量的可重复性和绝对结果方面的差异。
使用四个软件包（3mensio Vascular、TeraRecon、Vital Images和Aycan OsiriX PRO）对从我们的登记处选取的12例ECAA患者进行CT血管造影分析。从颅底到颈动脉分叉和主动脉弓计算迂曲指数（TI），并将其定义为中心线的实际长度除以直线距离。计算具有95%置信区间的组内相关系数（ICC），以量化一个软件包内观察者间和观察者内的变异性，以及各软件包之间测量的TI差异。
观察者间一致性对于3mensio几乎是完美的，对于Vital Images和OsiriX是优秀的，对于TeraRecon是实质性的，ICC分别为0.99（0.96 - 1.0）、0.90（0.69 -0.97）、0.84（0.53 - 0.95）和0.72（0.28 - 0.91）。观察者内一致性范围从3mensio的ICC 1.0到TeraRecon的0.91。TI的一致性范围从3mensio与OsiriX的ICC 0.99（0.98 - 1.0）到3mensio与TeraRecon的0.95（0.82 - 0.98）。完成一轮测量所需的中位时间以OsiriX最长（p = 0.013）。
颈动脉迂曲测量在当前市售软件包之间是可重复且可比的，观察者内一致性高。虽然每个软件包的可重复性不同，但所有软件包的观察者间一致性都达到了可接受水平。
