Skip to main content
SpringerLink
Log in

Reproducibility of Abdominal Aortic Aneurysm Diameter Measurement and Growth Evaluation on Axial and Multiplanar Computed Tomography Reformations

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To compare different methods measuring abdominal aortic aneurysm (AAA) maximal diameter (Dmax) and its progression on multidetector computed tomography (MDCT) scan.

Materials and Methods

Forty AAA patients with two MDCT scans acquired at different times (baseline and follow-up) were included. Three observers measured AAA diameters by seven different methods: on axial images (anteroposterior, transverse, maximal, and short-axis views) and on multiplanar reformation (MPR) images (coronal, sagittal, and orthogonal views). Diameter measurement and progression were compared over time for the seven methods. Reproducibility of measurement methods was assessed by intraclass correlation coefficient (ICC) and Bland–Altman analysis.

Results

Dmax, as measured on axial slices at baseline and follow-up (FU) MDCTs, was greater than that measured using the orthogonal method (p = 0.046 for baseline and 0.028 for FU), whereas Dmax measured with the orthogonal method was greater those using all other measurement methods (p-value range: <0.0001–0.03) but anteroposterior diameter (p = 0.18 baseline and 0.10 FU). The greatest interobserver ICCs were obtained for the orthogonal and transverse methods (0.972) at baseline and for the orthogonal and sagittal MPR images at FU (0.973 and 0.977). Interobserver ICC of the orthogonal method to document AAA progression was greater (ICC = 0.833) than measurements taken on axial images (ICC = 0.662–0.780) and single-plane MPR images (0.772–0.817).

Conclusion

AAA Dmax measured on MDCT axial slices overestimates aneurysm size. Diameter as measured by the orthogonal method is more reproducible, especially to document AAA progression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Nevitt MP, Ballard DJ, Hallett JW Jr (1989) Prognosis of abdominal aortic aneurysms. A population-based study. N Engl J Med 321:1009–1014

    Article  PubMed  CAS  Google Scholar 

  2. Katz DA, Littenberg B, Cronenwett JL (1992) Management of small abdominal aortic aneurysms. Early surgery vs watchful waiting. JAMA 268:2678–2686

    Article  PubMed  CAS  Google Scholar 

  3. The UK Small Aneurysm Trial Participants (1988) Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms. Lancet 352:1649–1655

    Google Scholar 

  4. Brewster DC, Cronenwett JL, Hallett JW Jr, Johnston KW, Krupski WC, Matsumura JS (2003) Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg 37:1106–1117

    Article  PubMed  Google Scholar 

  5. Brady AR, Thompson SG, Fowkes FG, Greenhalgh RM, Powell JT (2004) Abdominal aortic aneurysm expansion: risk factors and time intervals for surveillance. Circulation 110:16–21

    Article  PubMed  Google Scholar 

  6. Wolf YG, Hill BB, Rubin GD, Fogarty TJ, Zarins CK (2000) Rate of change in abdominal aortic aneurysm diameter after endovascular repair. J Vasc Surg 32:108–115

    Article  PubMed  CAS  Google Scholar 

  7. Hackmann AE, Rubin BG, Sanchez LA, Geraghty PA, Thompson RW, Curci JA (2008) A randomized, placebo-controlled trial of doxycycline after endoluminal aneurysm repair. J Vasc Surg 48:519–526 (discussion 526)

    Article  PubMed  Google Scholar 

  8. Gadowski GR, Pilcher DB, Ricci MA (1994) Abdominal aortic aneurysm expansion rate: effect of size and beta-adrenergic blockade. J Vasc Surg 19:727–731

    Article  PubMed  CAS  Google Scholar 

  9. Hatakeyama T, Shigematsu H, Muto T (2001) Risk factors for rupture of abdominal aortic aneurysm based on three-dimensional study. J Vasc Surg 33:453–461

    Article  PubMed  CAS  Google Scholar 

  10. Kritpracha B, Beebe HG, Comerota AJ (2004) Aortic diameter is an insensitive measurement of early aneurysm expansion after endografting. J Endovasc Ther 11:184–190

    Article  PubMed  Google Scholar 

  11. van Prehn J, van der Wal MB, Vincken K, Bartels LW, Moll FL, van Herwaarden JA (2008) Intra- and interobserver variability of aortic aneurysm volume measurement with fast CTA postprocessing software. J Endovasc Ther 15:504–510

    Article  PubMed  Google Scholar 

  12. Wever JJ, Blankensteijn JD, Th MMWP, Eikelboom BC (2000) Maximal aneurysm diameter follow-up is inadequate after endovascular abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 20:177–182

    Article  PubMed  CAS  Google Scholar 

  13. Wolf YG, Tillich M, Lee WA, Fogarty TJ, Zarins CK, Rubin GD (2002) Changes in aneurysm volume after endovascular repair of abdominal aortic aneurysm. J Vasc Surg 36:305–309

    Article  PubMed  Google Scholar 

  14. Bley TA, Chase PJ, Reeder SB et al (2009) Endovascular abdominal aortic aneurysm repair: nonenhanced volumetric CT for follow-up. Radiology 253(1):253–262

    Google Scholar 

  15. Bargellini I, Cioni R, Petruzzi P et al (2005) Endovascular repair of abdominal aortic aneurysms: analysis of aneurysm volumetric changes at mid-term follow-up. Cardiovasc Intervent Radiol 28:426–433

    Article  PubMed  Google Scholar 

  16. White RA, Donayre CE, Walot I, Woody J, Kim N, Kopchok GE (2001) Computed tomography assessment of abdominal aortic aneurysm morphology after endograft exclusion. J Vasc Surg 33(Suppl 2):S1–S10

    Article  PubMed  CAS  Google Scholar 

  17. van Keulen JW, van Prehn J, Prokop M, Moll FL, van Herwaarden JA (2009) Potential value of aneurysm sac volume measurements in addition to diameter measurements after endovascular aneurysm repair. J Endovasc Ther 16:506–513

    Article  PubMed  Google Scholar 

  18. Lederle FA, Wilson SE, Johnson GR et al (1995) Variability in measurement of abdominal aortic aneurysms. Abdominal Aortic Aneurysm Detection and Management Veterans Administration Cooperative Study Group. J Vasc Surg 21:945–952

    Article  PubMed  CAS  Google Scholar 

  19. Dillavou ED, Buck DG, Muluk SC, Makaroun MS (2003) Two-dimensional versus three-dimensional CT scan for aortic measurement. J Endovasc Ther 10:531–538

    Article  PubMed  Google Scholar 

  20. Aarts NJ, Schurink GW, Schultze Kool LJ et al (1999) Abdominal aortic aneurysm measurements for endovascular repair: Intra- and interobserver variability of CT measurements. Eur J Vasc Endovasc Surg 18:475–480

    Article  PubMed  CAS  Google Scholar 

  21. Matsumura JS, Pearce WH, McCarthy WJ, Yao JS (1997) Reduction in aortic aneurysm size: early results after endovascular graft placement. EVT Investigators. J Vasc Surg 25:113–123

    Article  PubMed  CAS  Google Scholar 

  22. Rhee RY, Eskandari MK, Zajko AB, Makaroun MS (2000) Long-term fate of the aneurysmal sac after endoluminal exclusion of abdominal aortic aneurysms. J Vasc Surg 32:689–696

    Article  PubMed  CAS  Google Scholar 

  23. Wanhainen A, Bergqvist D, Bjorck M (2002) Measuring the abdominal aorta with ultrasonography and computed tomography—difference and variability. Eur J Vasc Endovasc Surg 24:428–434

    Article  PubMed  CAS  Google Scholar 

  24. Abada HT, Sapoval MR, Paul JF, de Maertelaer V, Mousseaux E, Gaux JC (2003) 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

    Article  PubMed  Google Scholar 

  25. Singh K, Jacobsen BK, Solberg S et al (2003) Intra- and interobserver variability in the measurements of abdominal aortic and common iliac artery diameter with computed tomography. The Tromso Study. Eur J Vasc Endovasc Surg 25:399–407

    Article  PubMed  CAS  Google Scholar 

  26. Cayne NS, Veith FJ, Lipsitz EC et al (2004) Variability of maximal aortic aneurysm diameter measurements on CT scan: significance and methods to minimize. J Vasc Surg 39:811–815

    Article  PubMed  Google Scholar 

  27. Sprouse LR II, Meier GH III, Parent FN, DeMasi RJ, Glickman MH, Barber GA (2004) Is ultrasound more accurate than axial computed tomography for determination of maximal abdominal aortic aneurysm diameter? Eur J Vasc Endovasc Surg 28:28–35

    Article  PubMed  Google Scholar 

  28. Chaikof EL, Blankensteijn JD, Harris PL et al (2002) Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg 35:1048–1060

    Article  PubMed  Google Scholar 

  29. Elkouri S, Panneton JM, Andrews JC et al (2004) Computed tomography and ultrasound in follow-up of patients after endovascular repair of abdominal aortic aneurysm. Ann Vasc Surg 18:271–279

    Article  PubMed  Google Scholar 

  30. Sprouse LR II, Meier GH III, Lesar CJ et al (2003) Comparison of abdominal aortic aneurysm diameter measurements obtained with ultrasound and computed tomography: is there a difference? J Vasc Surg 38:466–471 (discussion 471–462)

    Article  PubMed  Google Scholar 

  31. Bargellini I, Cioni R, Napoli V et al (2009) Ultrasonographic surveillance with selective CTA after endovascular repair of abdominal aortic aneurysm. J Endovasc Ther 16:93–104

    Article  PubMed  Google Scholar 

  32. Singh K, Jacobsen BK, Solberg S, Kumar S, Arnesen E (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 aneurysmal aortas. The Tromso Study, 1994–1995. Eur J Vasc Endovasc Surg 28:158–167

    PubMed  CAS  Google Scholar 

  33. Jaakkola P, Hippelainen M, Farin P, Rytkonen H, Kainulainen S, Partanen K (1996) Interobserver variability in measuring the dimensions of the abdominal aorta: comparison of ultrasound and computed tomography. Eur J Vasc Endovasc Surg 12:230–237

    Article  PubMed  CAS  Google Scholar 

  34. Wever JJ, Blankensteijn JD, van Rijn JC, Broeders IA, Eikelboom BC, Mali WP (2000) Inter- and intraobserver variability of CT measurements obtained after endovascular repair of abdominal aortic aneurysms. AJR Am J Roentgenol 175:1279–1282

    PubMed  CAS  Google Scholar 

  35. Olabarriaga SD, Rouet JM, Fradkin M, Breeuwer M, Niessen WJ (2005) Segmentation of thrombus in abdominal aortic aneurysms from CTA with nonparametric statistical grey level appearance modeling. IEEE Trans Med Imaging 24:477–485

    Article  PubMed  Google Scholar 

  36. Kauffmann C, Tang A, Dugas A, Therasse E, Oliva V, Soulez G (2009) Clinical validation of a software for quantitative follow-up of abdominal aortic aneurysm maximal diameter and growth by CT angiography. Eur J Radiol 77(3):502–508

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by a clinical research scholarship (to G. S.) from Fonds de la Recherche en Santé du Québec; an operating grant from the Ministère du Développement Économique, de L’innovation et de L’exportation du Québec (Grant No. PSVT3-12792); and the Canadian Head of Academic Radiologist.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Radiology, Centre Hospitalier de l’Université de Montreal (CHUM) and CHUM Research Center (CRCHUM), University of Montreal, Montreal, QC, Canada

    Alexandre Dugas, Éric Therasse, Claude Kauffmann, An Tang, Marie-France Giroux, Vincent L. Oliva & Gilles Soulez

  2. Department of Surgery, Centre Hospitalier de l’Université de Montreal (CHUM), University of Montreal, Montreal, QC, Canada

    Stephane Elkouri

  3. Montreal Heart Institute Coordinating Centre, Institut de Cardiologie de Montréal, Montreal, QC, Canada

    Anna Nozza

Authors
  1. Alexandre Dugas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Éric Therasse
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claude Kauffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. An Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stephane Elkouri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anna Nozza
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marie-France Giroux
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Vincent L. Oliva
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gilles Soulez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gilles Soulez.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dugas, A., Therasse, É., Kauffmann, C. et al. Reproducibility of Abdominal Aortic Aneurysm Diameter Measurement and Growth Evaluation on Axial and Multiplanar Computed Tomography Reformations. Cardiovasc Intervent Radiol 35, 779–787 (2012). https://doi.org/10.1007/s00270-011-0259-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-011-0259-y

Keywords

Search

Navigation