Advertisement

Gefässchirurgie

, Volume 19, Issue 6, pp 558–563 | Cite as

Ultraschalldiagnostik der abdominellen Aorta

  • W. SchäberleEmail author
  • L. Leyerer
  • W. Schierling
  • K. Pfister
Leitthema

Zusammenfassung

Hintergrund und Fragestellung

Ideal für Screeninguntersuchungen ist eine Methode, die möglichst nebenwirkungsfrei, leicht erlernbar und somit breit einsetzbar mit hoher Treffsicherheit ein abdominelles Aortenaneurysma (AAA) erkennt. Obwohl die Sonographie diese Kriterien erfüllt, ist die Messmethode nicht standardisiert. Sowohl in Ultraschall- als auch in CT-Studien werden unterschiedliche Messmethoden angewandt und nur in 57 % der Fälle wird überhaupt die Messmethode ausreichend beschrieben.

Methode

Kritisches Review der aktuellen Literatur zu Messmethodik und Validität der Sonographie bei der Durchmesserbestimmung der Aorta insbesondere beim AAA und Darstellung von Messprinzipien zur möglichst exakten Messung.

Ergebnisse und Schlussfolgerungen

Die exakteste Durchmesserbestimmung wird EKG-getriggert, nach der Leading-edge-Methode mit orthogonaler Schnittführung (zur Gefäßachse) durchgeführt. Im Rahmen von Screeninguntersuchungen ist eine ausreichende Messgenauigkeit bei Einhaltung der orthogonalen Schnittführung erreicht.

Die Sonographie zeigt bei dieser standardisierten Messmethode auch im Methodenvergleich zum CT valide, reproduzierbare Ergebnisse und ist für Screeninguntersuchungen zum AAA die Methode der Wahl.

Schlüsselwörter

Sonographie Aortenaneurysma Messmethode Orthogonale Messung Vergleichsuntersuchung CT 

Ultrasound diagnostics of the abdominal aorta

Abstract

Background and objectives

The ideal method for screening investigations is one which is as free as possible from side effects, is easily learnt and can therefore be broadly employed to recognize abdominal aortic aneurysms (AAA) with a high degree of certainty. Although ultrasonography fulfils these criteria, the measurement method is not standardized. Different measurement methods are used in ultrasonography as well as in computed tomography (CT) studies and the measurement method is actually described sufficiently in only 57 % of cases.

Methods

This article gives a critical review of the current literature on measurement methods and the validity of ultrasonography for determination of the diameter of the aorta, particularly for AAAs and presents the measurement principles for making measurements as precisely as possible.

Results and conclusion

The most precise determination of the diameter is carried out by electrocardiogram (ECG) gating according to the leading edge method with orthogonal slicing. Within the framework of screening investigations, sufficient measurement precision can be achieved by adherence to orthogonal slicing. In these standardized measurement methods ultrasonography shows valid and reproducible results even in comparison to CT and is the method of choice in screening investigations for AAAs.

Keywords

Sonography Aortic aneurysm Measurement methods Orthogonal measurement Comparative study CT 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt. W. Schäberle, L. Leyerer, W. Schierling und K. Pfister geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Supplementary material

Videosequenz zur Darstellung eines AAA mit herzzyklusabhängiger Durchmesserschwankung (AVI 111MB)

Literatur

  1. 1.
    Beales L, Wolstenhumlme S, Evans JA et al (2011) Reproducibility of ultrasound measurement of abdominal aorta. Br J Surg 98(11):1517–1525PubMedCrossRefGoogle Scholar
  2. 2.
    Bredahl K, Taudorf M, Long A et al (2013) Three-dimensional ultrasound improves the accuracy of diameter measurement of the residual sac in EVAR patients. Eur J Vasc Endovasc Surg 46(5):525–532PubMedCrossRefGoogle Scholar
  3. 3.
    Bredahl K, Eldrup NB, Meyer C et al (2013) Reproducibility of ECG-gated ultrasound diameter assessment of small abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 45(3):235–240PubMedCrossRefGoogle Scholar
  4. 4.
    Chiu KW, Ling L, Tripathi V et al (2014) Ultrasound measurement for abdominal aortic aneurysm screening: a direct comparison of the three leading methods. Eur J Vasc Endovasc Surg 47(4):367–373PubMedCrossRefGoogle Scholar
  5. 5.
    Ellis M, Powell JT, Greenhalgh RM (1991) Limitations of ultrasonography in surveillance of small abdominal aortic aneurysms. Br J Surg 78(5):614–616PubMedCrossRefGoogle Scholar
  6. 6.
    Foo FJ, Hammond CJ, Goldstone AR et al (2011) Agreement between computed tomography and ultrasound on abdominal aortic aneurysms and implications on clinical decisions. Eur J Vasc Endovasc Surg 42:608–614PubMedCrossRefGoogle Scholar
  7. 7.
    Grondal N, Bramsen MB, Thomson MD et al (2012) The cardiac cycle is a major contributor to variability in size measurement of infrarenal abdominal aortic aneurysm by ultrasound. Eur J Vasc Endovasc Surg 43(1):30–33PubMedCrossRefGoogle Scholar
  8. 8.
    Harthorne TC, McCollum CN, Earnshaw JJ et al (2011) Ultrasound measurement of aortic diameter in a national screening programme. Eur J Vasc Endovasc Surg 42(2):195–199CrossRefGoogle Scholar
  9. 9.
    Hyhlik-Dürr A, Debus S, Eckstein HH et al (2011) Ultrasound screening in abdominal aortic aneurysm–numbers, data, facts. Zentralbl Chir 136(4):390Google Scholar
  10. 10.
    Jaakkola P, Hippeläinen M, Farin P et al (1996) Interobserver variability in measuring the dimension of the abdominal aorta: comparison of ultrasound and computed tomography. Eur J Vasc Endovasc Surg 12:230–237PubMedCrossRefGoogle Scholar
  11. 11.
    Lanne T, Sandgren T, Mangell P et al (1997) Improved reliability of ultrasonic surveillance of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 13(2):149–153PubMedCrossRefGoogle Scholar
  12. 12.
    Lindholdt JS, Vammen S, Juul S et al (1999) The validity of ultrasonographic scanning as screening method for abdominal aortic aneurysm. Eur J Vasc Endovasc Surg 17(6):472–475CrossRefGoogle Scholar
  13. 13.
    Lederle FA, Wilson SE, Johnson GR et al (1995) For the Abdominal Aortic Aneurysm Detection and Management Veterans Administration Cooperativ Study Group. Variability in measure of abdominal aortic aneurysms. J Vasc Surg 21:945–952PubMedCrossRefGoogle Scholar
  14. 14.
    Long A, Rouet L, Lindholdt JS, Allaire E (2012) Measuring the maximum diameter of native abdominal aortic aneurysms: review and critical analysis. Eur J Vasc Endovasc Surg 43:515–521PubMedCrossRefGoogle Scholar
  15. 15.
    Manning BJ, Kristmundsson T, Sonesson B, Resch T (2009) Abdominal aortic aneurysm diameter: a comparison of ultrasound measurements with those from standard and three-dimensional computed tomography reconstracions. J Vasc Surg 50:263–268PubMedCrossRefGoogle Scholar
  16. 16.
    Mastracci TM, Ciná CS (2007) Screening for abdominal aortic aneurysm in Canada: review and position statement of the Canadian Society for Vascular Surgery. J Vasc Surg 45(6):1268–1276PubMedCrossRefGoogle Scholar
  17. 17.
    Moll FL, Powell JT, Fraedrich G et al (2011) Management of abdominal aortic aneurysms. Clinical practice guidelines of the European Society of vascular Surgery. Eur J Vasc Endovasc Surg 41:51–58CrossRefGoogle Scholar
  18. 18.
    Pfister K, Kasprzak P, Apfelbeck H et al (2014) Hochauflösende 3-D-Sonographie und Bildfusion mit der CT-Angiographie – Herausforderungen und Möglichkeiten. Gefässchirurgie (im Druck)Google Scholar
  19. 19.
    Pleumeekers HJ, Hoes AW, Mulder PG et al (1998) Differences in observer variability of ultrasound measurement of the proximal and distal aorta. J Med Screen 5(2):104–108PubMedCrossRefGoogle Scholar
  20. 20.
    Schäberle W (2009) Ultraschall in der Gefäßdiagnostik, 3. Aufl. Springer, Heidelberg, S 20, 416–420, 459Google Scholar
  21. 21.
    Singh K, Jacobsen BK, Solberg S et al (2004) The difference between ultrasound and computed tomography (CT) measurements of aortic diameter increases with aortic diameter: analysis of axial images of abdominal aortic and common iliac artery diameter in normal and aneurismal aortas. The Tromsø Study, 1994–1995. Eur J Vasc Endovasc Surg 28:158–167PubMedCrossRefGoogle Scholar
  22. 22.
    Sprouse LR, Meier GH, Lesar CJ et al (2003) A comparison of abdominal aortic aneurysm diameter measurements obtained by ultrasound and computerized tomography: is there a difference? J Vasc Surg 38(3):466–471PubMedCrossRefGoogle Scholar
  23. 23.
    Sprouse LR, Meier GH, Parent FN et al (2004) Is ultrasound more accurate than axial computed tomography for determination of maximal abdominal aortic aneurysm diameter? Eur J Vasc Endovasc Surg 28:28–35PubMedCrossRefGoogle Scholar
  24. 24.
    Thanos J, Rebeira M, Shragge BW, Urbach D (2008) Vascular ultrasound screening for asymptomatic abdominal aortic aneurysm. Health Policy 4(2):75–83Google Scholar
  25. 25.
    Thomas PR, Shaw JC, Asthon HA et al (1994) Accuracy of ultrasound in a screening programme for abdominal aortic aneurysms. J Med Screen 1(1):3–6PubMedGoogle Scholar
  26. 26.
    Vidakovic R, Feringa HH, Kuiper RJ et al (2007) Comparison with computed tomography of two ultrasound devices for diagnosis of abdominal aortic aneurysm. Am J Cardiol 100(12):1786–1791PubMedCrossRefGoogle Scholar
  27. 27.
    Wanhainen A, Berqvist D, Björck M (2002) Measuring the abdominal aorta with ultrasonography and computed tomography – difference and variability. Eur J Vasc Endovasc Surg 24:428–434PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • W. Schäberle
    • 1
    Email author
  • L. Leyerer
    • 1
  • W. Schierling
    • 2
  • K. Pfister
    • 2
  1. 1.Klinik für Viszeral-, Gefäß-, Thorax- und KinderchirurgieKlinik am Eichert GöppingenGöppingenDeutschland
  2. 2.Gefäß- und endovaskuläre ChirurgieUniversitätsklinikum RegensburgRegensburgDeutschland

Personalised recommendations