What Is the Optimal Abdominal Aortic Aneurysm Sac Measurement on CT Images during Follow-up after Endovascular Repair?
What Is the Optimal Abdominal Aortic Aneurysm Sac Measurement on CT Images during Follow-up after Endovascular Repair?
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DOI：
10.1148/radiol.2017161424
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发表时间：
2017-12-01
期刊：
影响因子：
19.7
通讯作者：
Raptopoulos, Vasillios
中科院分区：
文献类型：
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作者：
Boos, Johannes;Brook, Olga R.;Raptopoulos, Vasillios
目的：开发一种具有二维和三维测量的计算机断层扫描 (CT) 血管造影后处理方案，用于对接受血管内主动脉修复术的患者进行随访。材料和方法：这项符合 HIPAA 的机构审查委员会批准的回顾性研究包括 159 名患者（129 名男性，30 名女性；平均年龄 +/- 标准差，74.9 岁 +/- 8.2），他们接受了 824 次 CT 检查（中位数为 5 次） 2004 年 9 月至 2015 年 3 月期间进行的未增强动脉期成像检查（范围为 2 至 14 次）。轴平面上的最大直径；垂直于重建中心线的冠状、矢状和最大直径；腹主动脉瘤囊的体积；测量从最低肾动脉到主动脉分叉处和髂总动脉分叉处的体积。将造影剂增强图像上的内漏视为参考标准，并分析直径和体积变化的预测值。使用组内相关性来比较直径和体积。结果：所有直径和体积均显示出极好的相关性（组内系数分别为 0.95 和 0.94）。直径和体积的平均观察者间差异分别为 2%-3% 和 4%-12%。 159 名患者中有 80 名 (50%) 观察到内漏（最初进行 CT 血管造影时有 59 名患者 [74%]，后来进行 CT 血管造影时有 21 名患者 [26%]）。新的内漏与动脉瘤尺寸增加相关，动脉瘤尺寸测量为轴向平面上的最大直径（P = .04）和垂直于中心线（P = .01），并且测量从最低肾动脉到主动脉分叉（P = .03）和髂总动脉分叉（P = .01）的体积。以 5% 的尺寸阈值，检测内漏的敏感性和特异性对于中心线直径（分别为 64.3% 和 81.7%）和从最低肾动脉到髂总动脉分叉处的体积（57.1% 和 63.5%）而言是最佳的。结论：腹主动脉瘤囊的最大直径和体积可用于血管内主动脉修复术后的时间监测，具有良好的相关性和观察者间的监测。协议。从最低肾动脉到髂分叉的中心线直径和体积的增加是检测内漏的最敏感标准。 (C) 北美放射学会，2017
Purpose: To develop a computed tomographic (CT) angiographic post-processing protocol with two-and three-dimensional measurements for follow-up of patients who underwent endovascular aortic repair.Materials and Methods: This HIPAA-compliant institutional review board-approved retrospective study included 159 patients (129 men, 30 women; mean age +/- standard deviation, 74.9 years +/- 8.2) who underwent 824 CT examinations (median of five examinations per patient; range, two to 14) with unenhanced and arterial -phase imaging performed between September 2004 and March 2015. The largest diameter on the axial plane; coronal, sagittal, and maximal diameter perpendicular to the reconstructed centerline; volume of the abdominal aortic aneurysm sac; and volume from the lowest renal artery to the aortic bifurcation and to the common iliac artery bifurcation were measured. Endoleaks on contrast material-enhanced images were considered the reference standard, and the predictive value of diameter and volume changes was analyzed. Intraclass correlation was used to compare diameters and volumes.Results: All diameters and volumes showed excellent correlation (intraclass coefficient, 0.95 and 0.94, respectively). Average interobserver difference for diameters and volumes was 2%-3% and 4%-12%, respectively. Endoleaks were observed in 80 (50%) of 159 patients (59 [74%] at initial and 21 [26%] at later CT angiography). New endo-leaks were associated with increased aneurysm size measured as the largest diameter on the axial plane (P = .04) and perpendicular to the centerline (P = .01), and volume was measured from the lowest renal artery to the aortic bifurcation (P = .03) and to the common iliac artery bifurcation (P = .01). With a 5% size threshold, sensitivity and specificity for detection of endoleaks was optimal for centerline diameter (64.3% and 81.7%, respectively) and volume from the lowest renal artery to the common iliac artery bifurcation (57.1% and 63.5%).Conclusion: The maximal diameter and volume of an abdominal aortic aneurysm sac can be used for temporal monitoring after endovascular aortic repair, with excellent correlation and interobserver agreement. An increase in the centerline diameter and volume from the lowest renal artery to the iliac bifurcation were the most sensitive criteria for detecting endoleaks. (C) RSNA, 2017