Ultrasound Measurement for Abdominal Aortic Aneurysm Screening: A Direct Comparison of the Three Leading Methods
Ultrasound Measurement for Abdominal Aortic Aneurysm Screening: A Direct Comparison of the Three Leading Methods
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DOI：
10.1016/j.ejvs.2013.12.026
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发表时间：
2014-04-01
影响因子：
5.7
通讯作者：
Shrivastava, V.
中科院分区：
文献类型：
--
作者：
Chiu, K. W. H.;Ling, L.;Shrivastava, V.
目的：超声（US）是一种非侵入性且具有成本效益的筛查腹主动脉瘤（AAA）的方法，但目前还没有普遍接受的方法来测量主动脉直径。本研究评估了三种方法的准确性、再现性和重复性：内-内（ITI）、前缘-前缘（LTL）和外-外（OTO）。本研究的次要目的是确定是否动脉瘤的大小或等级的操作者有任何影响内或interobservervariability.Methods：50静态US图像进行了测量，由6个评估员（2血管放射科医生，2介入放射学实习生，和2名超声）在两个独立的场合6周间隔。结果：三种方法在静态图像下均具有较高的重复性和再现性。ITI、LTL和OTO评估员之间的观察员间重现性系数分别为0.48 cm、0.35 cm和0.34 cm。ITI、LTL和OTO评估员之间的观察员内重复性系数分别为0.30 cm、0.20 cm和0.19 cm。CT与OTO、LTL和ITI之间的平均差异分别为1 mm、3 mm和5 mm（均为低估）（p < .0001）。结论：与CT相比，US始终低估主动脉大小，ITI显示低估最大（平均5 mm）。在英国，NHS腹主动脉瘤筛查项目的这种低估降低了筛查测试的敏感性，并可能影响血管专家解释筛查项目结果的方式。(C)2014年欧洲血管外科学会。由爱思唯尔有限公司出版。保留所有权利。
Objectives: Ultrasound (US) is non-invasive and cost-effective for screening abdominal aortic aneurysms (AAAs) but there is no universally accepted method to measure the aortic diameter. This study evaluates the accuracy, reproducibility, and repeatability of three methods: inner-to-inner (ITI), leading-to-leading edge (LTL), and outer-to-outer (OTO). The secondary objective of this study was to determine whether aneurysm size or grade of operator had any effect on either intra- or inter-observer variability.Methods: Fifty static US images were measured by six assessors (2 vascular radiologists, 2 interventional radiology trainees, and 2 sonographers) on two separate occasions 6 weeks apart. Repeatability and reproducibility were calculated and compared with computed tomography (CT) as the gold standard.Results: All three methods have high repeatability and reproducibility when static images are used. The inter-observer reproducibility coefficients between assessors were 0.48 cm, 0.35 cm, and 0.34 cm for ITI, LTL and OTO, respectively. The intra-observer repeatability coefficients between assessors were 0.30 cm, 0.20 cm, and 0,19 cm for ITI, LTL and OTO, respectively. The mean difference between CT and OTO, LTL, and ITI was 1 mm, 3 mm, and 5 mm, respectively (all underestimations) (p < .0001).Conclusions: US consistently underestimates aortic size when compared with CT, with ITI demonstrating the greatest underestimation (on average 5 mm). In the UK, this underestimation by the NHS Abdominal Aortic Aneurysm screening programme reduces the sensitivity of the screening test and may impact on the way in which vascular specialists interpret the findings of the screening programme. (C) 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.