Proximal thoracic aortic diameter measurements at CT: repeatability and reproducibility according to measurement method

Quint, Leslie E.; Liu, Peter S.; Booher, Anna M.; Watcharotone, Kuanwong; Myles, James D.

doi:10.1007/s10554-012-0102-9

Cited by 60 publications

(43 citation statements)

References 14 publications

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“…Nevertheless, this change may be below the normal variability range measurement of the different imaging techniques. Recent studies using ECG-gated CTA with state-of-the-art tools that are used in daily clinical practice, namely double-oblique short-axis and the semiautomatic centreline analysis technique, reported that differences of up to 2.5–5 mm in diameter occurred within the 95% CI 24 25. We believe that only a growth rate >3 mm/year with ECG-gated image and >5 m without may represent reasonable benchmarks of a clinically meaningful change.…”

Section: Surgical Indicationmentioning

confidence: 79%

Imaging aortic aneurysmal disease

Evangelista

2014

Heart

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Imaging techniques play a crucial role in the diagnosis, follow-up and management of aortic aneurysms. Ultrasound, CT and MRI have strengths and limitations in the assessment of this disease depending on the aorta segment involved, reason for the study (screening, follow-up or surgical indication) and patient characteristics. Ultrasound, transthoracic or abdominal, is highly useful in the diagnosis and follow-up of proximal ascending aorta and abdominal aorta aneurysms, respectively. However, other imaging modalities may be required to confirm measurements and add information on adjacent structures or the involvement of aortic branches. Transoesophageal echocardiography is frequently limited to perioperative indications. CT plays a central role in the diagnosis, risk stratification and management of most aneurysms, particularly those located distal to the proximal ascending aorta. Advantages of CT over other imaging modalities include rapid image acquisition, its multiplanar capacity with submillimetric spatial resolution and wide availability. The main limitations of CT are the radiation exposure and need for nephotoxic contrast administration. MRI is less readily available but overcomes these limitations and adds functional and biomechanical information, and is mainly indicated in young individuals who require repetitive studies and long-term follow-up. Aortic diameters are the cornerstone of current clinical practice in aortic aneurysms, and some limitations in accuracy and reproducibility measurements may generate errors in clinical decision making. Better understanding of imaging modalities, beyond the simple clinical application of diameters, may improve the management of this disease. In addition, new biomechanical and metabolic information could potentially provide a more reliable prediction of the risk of aneurysm rupture.

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Section: Surgical Indicationmentioning

confidence: 79%

Imaging aortic aneurysmal disease

Evangelista

2014

Heart

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“…Prior studies demonstrated overestimation of aortic aneurysm size by axial measures (which often pass obliquely through the aorta) when compared to double-oblique (oriented perpendicular to the axis of each aortic segment). (8, 17) In a recent study of 50 patients in GenTAC, aortic measures were significantly different at all measured segments between axial and double oblique measures. (8) In agreement with that study, our core lab CT measurements at the sinuses of Valsalva were smaller than those reported by Clinical Centers, likely reflecting our adoption of the double-oblique measures.…”

Section: Discussionmentioning

confidence: 95%

The Need for Standardized Methods for Measuring the Aorta

Asch

Yuriditsky

Prakash³

et al. 2016

JACC: Cardiovascular Imaging

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Objectives To evaluate variability in aortic measurements with multiple imaging modalities in clinical centers by comparing to a standardized measuring protocol implemented in a core lab. Background In patients with aortic disease, imaging of thoracic aorta plays a major role in risk-stratifying individuals for life-threatening complications and in determining timing of surgical intervention. However, standardization of the procedures for performance of aortic measurements is lacking. Methods To characterize the diversity of methods utilized in clinical practice, we compared aortic measurements performed by echo, CT and MRI at the 6 GenTAC clinical centers to those performed at the imaging core lab in 965 studies. Each center acquired and analyzed their images according to local protocols. The same images were subsequently analyzed blindly by the core lab, based on a standardized protocol for all imaging modalities. Paired measurements from clinical centers and core lab were compared by mean of differences and intra-class correlation coefficient (ICC). Results For all segments of the ascending aorta echo showed a higher ICC (0.84 to 0.93) than CT (0.84) and MRI (0.82 to 0.9), with smaller mean of differences. MRI showed higher ICC for the arch and descending aorta (0.91 and 0.93). In a mixed adjusted model, the different imaging modalities and clinical centers were identified as sources of variability between clinical and core lab measurements, while age groups or diagnosis at enrollment were not. Conclusion By comparing core lab to clinical center’s measurements, our study identified important sources of variability in aortic measurements. Furthermore, our findings with regard to CT and MRI suggest a need for imaging societies to work toward development of unifying acquisition protocols and common measuring methods.

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“…In several studies, variability of measurement of proximal aortic diameters ranges from 1.6 to 5 mm. 8,23,24,27,28 Given this degree of variability, apparent small changes in proximal aortic diameters on serial computed tomographic examinations may be within the range of measurement error. Accordingly, for all imaging techniques, we recommend that changes of #3 mm by electrocardiographically gated CT and #5 mm without electrocardiographic gating be viewed with caution and skepticism.…”

Section: Normal Aortic Dimensionsmentioning

confidence: 99%