Abstract
The aim of this study was to determine the variability of various measurement protocols for measurement of abdominal aortic aneurysm (AAA) and the clinical relevance of variability. Three radiologists performed computed tomographic angiography measurements of both the aorta and the largest portion of the aneurysm on selected axial slices. Then measurements of the largest portion of the aneurysm were performed on unselected axial slices, sagittal and coronal reformatted. Finally, aortic volume was calculated. Measurements and volume calculation were performed before and after endovascular repair and assessed: Part 1: interobserver variability for maximum anteroposterior (MAP) and maximum transverse (MTR) diameters on selected slices; part 2: interobserver variability for unselected slices considering MAP and MTR; part 3: interobserver variability considering maximum diameter in any direction (MAD); part 4: interobserver variability for sagittal (SAG) and coronal (COR) free curved multiplanar reformation (MPR); and part 5: volume calculations. We then determined which technique of measurement was the most clinically relevant for detecting changes in aneurysm size or aortic volume. Parts 1 and 2: interobserver variability was 4.1 mm for both MAP and MTR; part 3: interobserver variability was 7 mm for MAD; part 4: interobserver variability was 5.5 mm (COR) and 4.9 mm (SAG); part 5: interobserver variability for volume was 5.5 ml. A combination of MAP and MTR was the most useful for detecting aortic modification. Volume calculation was needed in only a few cases. We recommend avoiding MAD and MPR measurements and suggest instead measuring both maximum anteroposterior and maximum transverse diameters. If aneurysm size remains stable after endovascular repair, aneurysm volume should be measured.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.References
Parodi JC, Criado FJ, Barone HD, Schonholz CS, Queral LA (1994) Endoluminal aortic aneurysm repair using a balloon-expandable stent-graft device: a progress report. Ann Vasc Surg 8:523–529
Blum U, Langer M, Spillner G et al. (1996) Abdominal aortic aneurysms: preliminary technical and clinical results with transfemoral placement of endovascular self-expanding stent-grafts. Radiol 198:25–31
Doffner R, Thurner S, Polterauer P, Kretscnmer G, Lammer J (1997) Treatment of abdominal aortic aneurysms with transfemoral placement of stent-grafts: complications and secondary radiologic intervention. Radiology 204:79–86
Uflacker R, Robinson J (2001) Endovascular treatment of abdominal aortic aneurysm: a review. Eur Radiol 11:739–753
Thomas PR, Shaw JC, Ashton HA, Kay DN, Scott RA (1994) Accuracy of ultrasound in a screening program for abdominal aortic aneurysms. J Med Screen 1:3–6
Golzarian J, Dussaussois L, Struyven J (1999) Imaging of abdominal aortic aneurysm after endoluminal repair. Semin Ultrasound CT MR 20:16–24
Golzarian J, Struyven J (2001) Imaging of complications after endoluminal treatment of abdominal aortic aneurysm. Eur Radiol 11:2244–2251
Golzarian J, Dussaussois L, Abada HT et al. (1998) Helical CT of aorta after endoluminal stent-graft therapy: value of biphasic acquisition. AJR 171:329–331
Bland JM, Altman DG (1986) Statistical notes: measurement error. Br Med J 313:744
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 8:307–310
White GH, May J, Petrasek P, Waugh R, Stephen M, Harris J (1999) Endotension: an explanation for continued AAA growth after successful endoluminal repair. J Endovas Surg 6:308–315
Jaakola P, Hippelainen M, Farin P, Rytkonen H, Kainulainen S, Partanen K (1996) Interobserver variability in measuring the dimensions of abdominal aorta: comparison of ultrasound and computed tomography. Eur J Vasc Endovasc Surg 12:230–237
Lederle FA, Wilson SE, Johnson GR et al. (1995) Variability in measurement of abdominal aortic aneurysms. J Vasc Surg:945–952
Wever JJ, Blankensteijn, van Rijn, Broeders IA, Eikelboom, Mali WP (2000) Inter- and intraobserver variability of CT measurements obtained after endovascular repair. AJR 175:1279–1282
Wolf YG, Tillich M, Lee A, Fogarty TJ, Zarins CK, Rubin GD (2002) Changes in aneurysm volume after endovascular repair of abdominal aortic aneurysm. J Vasc Surg 36:305–309
Shin H, Chavan, Witthus F et al. (2001) Precise determination of aortic length in patients with aortic stent-grafts: in-vivo evaluation of a thinning algorithm applied to CT angiography data. Eur Radiol 11:733–738
Raman R, Napel S, Beaulieu CF, Bain ES, Brooke JR, Rubin GD (2002) Automated generation of curved planar reformations from volume data: method and evaluation. Radiology 223:275–280
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Abada, H.T., Sapoval, M.R., Paul, JF. et al. Aneurysmal sizing after endovascular repair in patients with abdominal aortic aneurysm: interobserver variability of various measurement protocols and its clinical relevance. Eur Radiol 13, 2699–2704 (2003). https://doi.org/10.1007/s00330-003-1914-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-003-1914-8