Intra- and Interobserver Reliability and Variability of Femoral Artery Pseudoaneurysm Measurements Between Pre- and Postprocessed B-mode Sonographic Images

Abstract

Pseudoaneurysms are a major source of morbidity after cardiac catheterization. 1 Femoral artery pseudoaneurysm (FAP), also known as a false aneurysm, is a pulsating encapsulated hematoma in communication with a ruptured vessel. 2 It is mostly formed after surgical procedures, penetrating trauma, or femoral fractures. 3 The incidence of FAP after diagnostic catheterization and routine percutaneous intervention ranges from 0.05% to 2%. 4,5 The incidence increases to 6% after more complex and emergent procedures, such as primary percutaneous intervention, for acute myocardial infarction, prolonged multivessel intervention, or procedures. 4,5 These procedures usually require larger sheath sizes (e.g., 8 French gauge). The early diagnosis of FAP is crucial to avoid further complications, such as a rupture, and for treatment planning. 6 Computed tomography (CT) can be used to detect a FAP and provides high-resolution imaging of the FAP structure. 7 However, CT may not be readily available, and the pre-and postcontrast CT imaging depends on exposure to ionizing radiation. Therefore, ultrasonography (US) remains a safe alternative method for the diagnostic imaging of patients with groin complications postcatheterization. 8 US involves the use of nonionizing radiation and no contrast agent, and it is noninvasive, inexpensive, portable, and readily available. 9 However, one of the main disadvantages of US for detecting a FAP is that it mainly provides details on the blood flow, as opposed to the structure. A FAP is diagnostically confirmed by looking at the characteristic bidirectional Doppler waveform in the neck as well as a swirling 819993J DMXXX10.

Reliability and Variability Assessment of Femoral Artery Pseudoaneurysm Measurements Between Pre- and Postprocessed B-mode Ultrasound Images

“…The overall purpose of this study was to compare the results with those obtained from a hospital database in the United States. 22 In terms of the average values for intra-and interobserver ICCs of the FAP sac width from original grayscale US images, this study yielded similar results (0.99 and 0.99) to a previous publication (0.98 and 0.96, respectively). 22 This study verified that all FAP measurements required for treatment options were more accurate in locating the FAP body and sac width as compared with the original B-mode US images.…”

“…All images were processed by a single operator using MATLAB R2018b software (MathWorks, Natick, MA) to enhance the contrast and to segment the FAP area from the background with the same preprocessing and segmentation method used in the previously cited study 22 (Figure 3).…”

“…21 The previously reported intra-and interobserver variability and reliability of the FAP measurements between pre-and postprocessed US images acquired from a major medical center in the United States showed that the influence of image processing was more profound on novice observers in repeating their measurements with less variability and high reliability. 22 Since diverse samples from multisite studies can provide results that are more generalizable, the aim was to Figure 1. Color flow duplex ultrasonographic images of femoral artery pseudoaneurysm acquired from a major medical center in Saudi Arabia.…”

“…21 The previously reported intra- and interobserver variability and reliability of the FAP measurements between pre- and postprocessed US images acquired from a major medical center in the United States showed that the influence of image processing was more profound on novice observers in repeating their measurements with less variability and high reliability. 22…”

“…This allowed for a comparison of results with previous findings based on US images acquired at a major medical center in the United States. 22 The hypothesis of this study was that the image-processing method used to obtain the previously published data 22 may yield comparable results when applied to images acquired from a foreign institution.…”