Is three-dimensional computed tomography reconstruction justified before endovascular aortic aneurysm repair?

Larry Richard Sprouse, George H. Meier, F. Noel Parent, Richard J. Demasi, Gordon K. Stokes, Christopher J. Lesar, Michael J. Marcinczyk, Bernardo Mendoza

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

The endovascular management of abdominal aortic aneurysm (AAA) relies on accurate preoperative imaging for proper patient selection and operative planning. Three-dimensional (3-D) computed tomography (CT) with reformatted images perpendicular to blood flow has gained popularity as a method of AAA assessment and image-based planning before endovascular aneurysm repair (EVAR). The current study was undertaken to determine the interobserver agreement of AAA measurements obtained with axial CT and reformatted 3-D CT and to compare the consistency of the 2 methods in selecting patients for EVAR. Eight observers assessed the axial CT and reformatted 3-D CT scans for 5 patients with AAAs to determine whether the patients were candidates for EVAR. 3-D CT with multiplanar reformatted images was performed by Medical Media Systems (MMS). Each observer measured the length and diameter of the proximal neck, maximal AAA, aortic bifurcation, common iliac diameter, and aortic angulation. The proximal neck and common iliac arteries were also assessed for thrombus, calcification, and tortuosity. Agreement of the measurements on axial CT scans was compared with those on MMS CT scans by calculating the κ statistic. Complete agreement was defined as κ = 1.0. The limits of agreement between observers were also calculated. The cumulative interobserver agreement of MMS CT scans (κ = .81) was greater than for axial CT scans (κ = .59). The κ value for each of the diameter measurements was greater with the MMS CT scans. In 79% of cases the observers' measurements were less than 2 mm from the mean with MMS CT, compared with 59% for axial CT. The κ value for deciding whether a patient was an endograft candidate on the basis of aortic neck was greater with the MMS CT (0.92 vs 0.63). The limits of agreement between observers were also better with the MMS CT. The interobserver agreement in planning EVAR is significantly better with MMS CT compared with traditional axial CT. The routine use of MMS CT appears justified before EVAR to improve the accuracy and consistency of patient selection.

Original languageEnglish (US)
Pages (from-to)443-447
Number of pages5
JournalJournal of Vascular Surgery
Volume40
Issue number3
DOIs
StatePublished - Sep 1 2004
Externally publishedYes

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Aortic Aneurysm
Tomography
Aneurysm
Abdominal Aortic Aneurysm
Patient Selection
Iliac Artery

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Is three-dimensional computed tomography reconstruction justified before endovascular aortic aneurysm repair? / Sprouse, Larry Richard; Meier, George H.; Parent, F. Noel; Demasi, Richard J.; Stokes, Gordon K.; Lesar, Christopher J.; Marcinczyk, Michael J.; Mendoza, Bernardo.

In: Journal of Vascular Surgery, Vol. 40, No. 3, 01.09.2004, p. 443-447.

Research output: Contribution to journalArticle

Sprouse, LR, Meier, GH, Parent, FN, Demasi, RJ, Stokes, GK, Lesar, CJ, Marcinczyk, MJ & Mendoza, B 2004, 'Is three-dimensional computed tomography reconstruction justified before endovascular aortic aneurysm repair?', Journal of Vascular Surgery, vol. 40, no. 3, pp. 443-447. https://doi.org/10.1016/j.jvs.2004.06.024
Sprouse, Larry Richard ; Meier, George H. ; Parent, F. Noel ; Demasi, Richard J. ; Stokes, Gordon K. ; Lesar, Christopher J. ; Marcinczyk, Michael J. ; Mendoza, Bernardo. / Is three-dimensional computed tomography reconstruction justified before endovascular aortic aneurysm repair?. In: Journal of Vascular Surgery. 2004 ; Vol. 40, No. 3. pp. 443-447.
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