Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.
Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
J Vasc Surg. 2021 Sep;74(3):979-987. doi: 10.1016/j.jvs.2021.02.031. Epub 2021 Mar 5.
Three-dimensional ultrasound (3D-US) has already demonstrated improved reproducibility with a high degree of agreement (intermodality variability), reproducibility (interoperator variability), and repeatability (intraoperator variability) compared with conventional two-dimensional ultrasound (2D-US) when estimating the maximum diameter of native abdominal aortic aneurysms (AAAs). The aim of the present study was, in a clinical, multicenter setting, to evaluate the accuracy of 3D-US with aneurysm model quantification software (3D-US abdominal aortic aneurysm [AAA] model) for endovascular aortic aneurysm repair (EVAR) sac diameter assessment vs that of computed tomography angiography (CTA) and 2D-US.
A total of 182 patients who had undergone EVAR from April 2016 to December 2017 and were compliant with a standardized EVAR surveillance program were enrolled from five different vascular centers (Rigshospitalet, Copenhagen, Denmark; Catharina Ziekenhuis, Eindhoven, Netherlands; L'hospital de la Timone, Paris, France; Cleveland Clinic, Cleveland, Ohio; and The Christ Hospital, Cincinnati, Ohio) in four countries. All image acquisitions were performed at the local sites (ie, 2D-US, 3D-US, CTA). Only the 2D-US and CTA readings were performed both locally and centrally. All images were read centrally by the US and CTA core laboratory. Anonymized image data were read in a randomized and blinded manner.
The sample used to estimate the accuracy of the 3D-US AAA model and 2D-US included 164 patients and 177 patients, respectively. The Bland-Altman analysis revealed that the mean difference between CTA and 3D-US was -2.43 mm (95% confidence interval [CI], -5.20 to 0.14; P = .07) with a lower and upper limit of agreement of -8.9 mm (95% CI, -9.3 to -8.4) and 2.7 mm (95% CI, 2.3-3.2), respectively. For 2D-US and CTA, the mean difference was -3.62 mm (95% CI, -6.14 to -1.10; P = .002), with a lower and upper limit of agreement of -10.3 mm (95% CI, -10.8 to -9.8) and 2.5 mm (95% CI, 2-2.9), respectively.
The 3D-US AAA model showed no significant difference compared with CTA for measuring the anteroposterior diameter, indicating less bias for 3D-US compared with 2D-US. Thus, 3D-US with AAA model software is a viable modality for anteroposterior diameter assessment for surveillance after EVAR.
与传统二维超声（2D-US）相比，三维超声（3D-US）在评估原发性腹主动脉瘤（AAA）的最大直径时，具有更高的可重复性（模式间变异性）、可重复性（操作者间变异性）和重复性（操作者内变异性）。本研究的目的是，在临床多中心环境中，使用动脉瘤模型量化软件（3D-US 腹主动脉瘤[AAA]模型）评估 3D-US 对血管内修复（EVAR）囊直径评估的准确性，与计算机断层血管造影术（CTA）和 2D-US 进行比较。
从 2016 年 4 月至 2017 年 12 月在五个不同的血管中心（丹麦哥本哈根的 Rigshospitalet、荷兰埃因霍温的 Catharina Ziekenhuis、法国巴黎的 L'hospital de la Timone、美国俄亥俄州克利夫兰的克利夫兰诊所和美国俄亥俄州辛辛那提的 The Christ Hospital）接受 EVAR 治疗并符合标准化 EVAR 监测计划的 182 例患者符合入选标准。所有图像采集均在当地进行（即 2D-US、3D-US、CTA）。只有 2D-US 和 CTA 读数在当地和中心进行。所有图像均由 US 和 CTA 核心实验室进行中心读取。匿名图像数据以随机和盲法方式读取。
用于估计 3D-US AAA 模型和 2D-US 准确性的样本分别包括 164 例和 177 例患者。Bland-Altman 分析显示，CTA 和 3D-US 之间的平均差异为-2.43mm（95%置信区间，-5.20 至 0.14；P=0.07），一致性界限分别为-8.9mm（95%置信区间，-9.3 至-8.4）和 2.7mm（95%置信区间，2.3-3.2）。对于 2D-US 和 CTA，平均差异为-3.62mm（95%置信区间，-6.14 至-1.10；P=0.002），一致性界限分别为-10.3mm（95%置信区间，-10.8 至-9.8）和 2.5mm（95%置信区间，2-2.9）。
3D-US AAA 模型在测量前后径方面与 CTA 无显著差异，表明与 2D-US 相比，3D-US 的偏差较小。因此，3D-US 结合 AAA 模型软件是 EVAR 后监测前后径的一种可行方法。
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