Department of Vascular Surgery, Heart Vascular and Thoracic Institute, The Cleveland Clinic, Cleveland, OH..
Department of Cardiovascular Imaging, Imaging Institute, The Cleveland Clinic, Cleveland, OH.
Ann Vasc Surg. 2022 Feb;79:264-272. doi: 10.1016/j.avsg.2021.07.049. Epub 2021 Oct 14.
There is no consensus on the method of obtaining abdominal aortic aneurysm (AAA) maximum diameters based on computed tomographic angiography, and the reproducibility and accuracy of different methods have recently been debated due to advancements in imaging. This study compared the two most common methods based on orthogonal planes and centerline of flow to determine the discordances and accuracy amongst experiences readers.
The computed tomographic angiography max diameters of 148 AAAs were measured by three experienced observers, including a vascular surgeon, a radiologist and an imaging cardiologist. Observers used two different methods with standardized protocols: multiplanar reformations based on orthogonal planes, and a software using 3D aortic reconstructions to create centerline flow lumen providing diameters based on cross sections perpendicular to this lumen. Agreements and reliability of measurement methods were assessed by intra-class correlation coefficient and Bland - Altman analysis. Discordances between measurements of the methods and the original reported measurement, as well as outside hospitals were compared.
The average age of the cohort was 75 years and aortic diameters ranged from 3.8 to 9.6 cm. For orthogonal readings, there were agreements within 3 mm between 86% and 92% of the time, while centerline - reading agreement was between 88% and 94%, which was not statistically significant. The intra-class correlation coefficient was high between method type and between readers. Within methods, agreement was between 0.96 and 0.97, while within - reader agreement measures was between 0.96 and 0.98. In comparison to the original and the outside hospital reports, 10% ≥ of the original and 20% ≥ of the outside hospital reported measurements were discordant between the readers.
Maximal AAA measurements can have substantial variability leading to clinical significance and change in patient management and outcomes. Based on the results, orthogonal and centerline measurement methods have equally high agreements and concordance within 3 mm and low variations at a high volume center. However, when compared to the official read reports, there is high discordance rates that can significantly alter patient outcomes. A standardized method of measurement maximum diameter can reduce variations and discordances among different methods.
在基于计算机断层血管造影术的情况下，对于获取腹主动脉瘤（AAA）最大直径的方法尚无共识，并且由于成像技术的进步，最近对于不同方法的可重复性和准确性也存在争议。本研究比较了两种最常用的基于正交平面和血流中心线的方法，以确定经验丰富的读者之间的差异和准确性。
三位经验丰富的观察者（包括血管外科医生、放射科医生和影像学心脏病专家）使用两种不同的标准化方案进行了计算机断层血管造影术的最大 AAA 直径测量：基于正交平面的多平面重建，以及一种使用 3D 主动脉重建来创建基于与该管腔垂直的横截面的中心线流腔的软件，从而提供直径。通过组内相关系数和 Bland - Altman 分析评估了测量方法的一致性和可靠性。比较了方法之间以及与原始报告测量值之间的测量差异，以及与外部医院之间的差异。
该队列的平均年龄为 75 岁，主动脉直径范围为 3.8 至 9.6 cm。对于正交读数，在 86%至 92%的时间内，两种方法之间的差异在 3mm 以内，而中心线读数的差异则在 88%至 94%之间，无统计学意义。方法类型之间以及读者之间的组内相关系数均较高。在方法内，一致性在 0.96 至 0.97 之间，而读者之间的一致性在 0.96 至 0.98 之间。与原始和外部医院的报告相比，10%≥的原始和 20%≥的外部医院报告的测量值在读者之间存在差异。
AAA 的最大测量值可能存在较大的差异，从而导致临床意义以及患者管理和预后的改变。基于这些结果，正交和中心线测量方法在 3mm 以内具有高度一致性和一致性，并且在高容量中心具有较低的变化。但是，与官方阅读报告相比，存在很高的不一致率，这可能会严重改变患者的预后。最大直径的标准化测量方法可以减少不同方法之间的差异和不一致性。
