1
|
Ribé L, Candela E, Gálvez L, Arrébola M, Plana E, Miralles M. Comparison of Three Workstations For Abdominal Aortic Aneurysm Sizing: Impact in Decision Making and Graft Selection. J Endovasc Ther 2024; 31:295-304. [PMID: 36124870 DOI: 10.1177/15266028221120767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this study was to assess the agreement of multiplanar reconstruction (MPR) and semiautomated central lumen line (CLL) analysis of abdominal aortic aneurysms (AAA), with 3 different software workstations (WS1, WS2, WS3) and 2 experienced practitioners as well as to analyze its eventual impact in graft selection. MATERIALS AND METHODS Twenty computed tomography (CT) angiography data sets were randomly chosen from a series of 100 consecutive studies. Measurements were performed twice by each reader, in random order, and included 8 parameters (5 diameters and 3 lengths). Each observer performed a complete set of 60 studies. Intra-observer and interobserver variability for every WS was assessed. Measurements were evaluated using Bland-Altman analysis, correlation coefficients (r), and concordance correlation coefficients (CCC [95% confidence interval (CI)]). RESULTS A high overall agreement between repeated measurements for both observers was obtained (r=0.989; CCC=0.988 [0.982-0.992] and r=0.998; CCC=0.996 [0.994-0.997], for observers 1 and 2, respectively). However, reproducibility for individual parameters was excellent for observer 2 and only moderate for observer 1. A high overall agreement was obtained for interobserver concordance (r=0.987; CCC=0.986 [0.982-0.989]). When analyzing for individual parameters, greatest interobserver differences were found at CLL measurement of the diameter of aortic neck (WS2) and bifurcation (WS1 and WS2) as well as iliac diameter in all 3 WS for both CLL and MPR. Similar differences were observed in paired comparison between WS when involving these parameters. Careful inspection of Bland-Altman charts revealed some cases of disagreement between WS and observers that would affect decision making on graft selection, changing the neck diameter to a different size, in 2 cases when measuring with WS1, and iliac diameter in 4 cases (2 of them with WS1 and 2 with WS2). Greatest discordance was observed regarding ipsilateral iliac length affecting 7 measurements that would lead to change the length of the selected limb graft (2 with WS1, 3 with WS2, and 2 with WS3). CONCLUSIONS Although a high agreement between different observers using different WS for AAA measurements is to be expected, small differences may lead to the selection of a different graft size. The use of a single software by experienced users, and double check by a different one, may be advisable. CLINICAL IMPACT Influence of inter and intraobserver variability in CT measurements during planning of endovascular aneurysm repair (EVAR) has been extensively reviewed. However, its impact in graft selection (final choose of diameter and lengths) has been scarcely analyzed. The results of this study suggest that, although a high agreement between different observers using different workstations for AAA measurements is to be expected, small differences may lead to the selection of a different graft size. The use of a single software by experienced users, and double check by a different one, may be advisable.
Collapse
Affiliation(s)
- Lucas Ribé
- Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Eliseo Candela
- Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Laura Gálvez
- Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Manel Arrébola
- Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Manuel Miralles
- Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Surgery Department, University of Valencia (UV), Spain
| |
Collapse
|
2
|
Contrella BN, Khaja MS, Majdalany BS, Kim CY, Kalva SP, Beck AW, Browne WF, Clough RE, Ferencik M, Fleischman F, Gunn AJ, Hickey SM, Kandathil A, Kim KM, Monroe EJ, Ochoa Chaar CI, Scheidt MJ, Smolock AR, Steenburg SD, Waite K, Pinchot JW, Steigner ML. ACR Appropriateness Criteria® Thoracoabdominal Aortic Aneurysm or Dissection: Treatment Planning and Follow-Up. J Am Coll Radiol 2023; 20:S265-S284. [PMID: 37236748 DOI: 10.1016/j.jacr.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
As the incidence of thoracoabdominal aortic pathology (aneurysm and dissection) rises and the complexity of endovascular and surgical treatment options increases, imaging follow-up of patients remains crucial. Patients with thoracoabdominal aortic pathology without intervention should be monitored carefully for changes in aortic size or morphology that could portend rupture or other complication. Patients who are post endovascular or open surgical aortic repair should undergo follow-up imaging to evaluate for complications, endoleak, or recurrent pathology. Considering the quality of diagnostic data, CT angiography and MR angiography are the preferred imaging modalities for follow-up of thoracoabdominal aortic pathology for most patients. The extent of thoracoabdominal aortic pathology and its potential complications involve multiple regions of the body requiring imaging of the chest, abdomen, and pelvis in most patients. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
| | | | - Bill S Majdalany
- Panel Chair, University of Vermont Medical Center, Burlington, Vermont
| | - Charles Y Kim
- Panel Chair, Duke University Medical Center, Durham, North Carolina
| | - Sanjeeva P Kalva
- Panel Vice-Chair, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam W Beck
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama; Society for Vascular Surgery
| | | | - Rachel E Clough
- St Thomas' Hospital, King's College, School of Biomedical Engineering and Imaging Science, London, United Kingdom; Society for Cardiovascular Magnetic Resonance
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Society of Cardiovascular Computed Tomography
| | - Fernando Fleischman
- Keck School of Medicine of USC, Los Angeles, California; American Association for Thoracic Surgery
| | - Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Sean M Hickey
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; American College of Emergency Physicians
| | - Asha Kandathil
- UT Southwestern Medical Center, Dallas, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Karen M Kim
- University of Michigan, Ann Arbor, Michigan; The Society of Thoracic Surgeons
| | | | | | | | - Amanda R Smolock
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Scott D Steenburg
- Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana; Committee on Emergency Radiology-GSER
| | - Kathleen Waite
- Duke University Medical Center, Durham, North Carolina, Primary care physician
| | - Jason W Pinchot
- Specialty Chair, University of Wisconsin, Madison, Wisconsin
| | | |
Collapse
|
3
|
Ghatwary TMH, Patterson BO, Karthikesalingam A, Hinchliffe RJ, Loftus IM, Morgan R, Thompson MM, Holt PJE. A systematic review of protocols for the three-dimensional morphologic assessment of abdominal aortic aneurysms using computed tomographic angiography. Cardiovasc Intervent Radiol 2013; 36:14-24. [PMID: 22159906 DOI: 10.1007/s00270-011-0296-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 10/09/2011] [Indexed: 10/14/2022]
Abstract
The morphology of infrarenal abdominal aortic aneurysms (AAAs) directly influences the perioperative outcome and long-term durability of endovascular aneurysm repair. A variety of methods have been proposed for the characterization of AAA morphology using reconstructed three-dimensional (3D) computed tomography (CT) images. At present, there is lack of consensus as to which of these methods is most applicable to clinical practice or research. The purpose of this review was to evaluate existing protocols that used 3D CT images in the assessment of various aspects of AAA morphology. An electronic search was performed, from January 1996 to the end of October 2010, using the Embase and Medline databases. The literature review conformed to PRISMA statement standards. The literature search identified 604 articles, of which 31 studies met inclusion criteria. Only 15 of 31 studies objectively assessed reproducibility. Existing published protocols were insufficient to define a single evidence-based methodology for preoperative assessment of AAA morphology. Further development and expert consensus are required to establish a standardized and validated protocol to determine precisely how morphology relates to outcomes after endovascular aneurysm repair.
Collapse
Affiliation(s)
- Tamer M H Ghatwary
- Department of Outcomes Research, St. George's Vascular Institute, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Müller-Eschner M, Rengier F, Partovi S, Weber TF, Kopp-Schneider A, Geisbüsch P, Kauczor HU, von Tengg-Kobligk H. Accuracy and variability of semiautomatic centerline analysis versus manual aortic measurement techniques for TEVAR. Eur J Vasc Endovasc Surg 2013; 45:241-7. [PMID: 23318135 DOI: 10.1016/j.ejvs.2012.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study aims to test whether inter-observer variability and time of diameter measurements for thoracic endovascular aortic repair (TEVAR) are improved by semiautomatic centerline analysis compared to manual assessment. METHODS Preoperative computed tomography (CT) angiographies of 30 patients with thoracic aortic disease (mean age 66.8 ± 11.6 years, 23 males) were retrospectively analysed by two blinded experts in vascular radiology. Maximum aortic diameters at three positions relevant to TEVAR were assessed (P1, distal to left common carotid artery; P2, distal to left subclavian artery; and P3, proximal to coeliac trunk) using three measurement techniques: manual axial slices (axial), manual double-oblique multiplanar reformations (MPRs) and semiautomatic centerline analysis. RESULTS Diameter measurements by both centerline analysis and the axial technique did not significantly differ from MPR (p = 0.17 and p = 0.37). Total deviation index for 0.9 was for P1 2.7 mm (axial), 3.7 mm (MPR), 1.8 mm (centerline); for P2 2.0 mm (axial), 3.6 mm (MPR), 1.8 mm (centerline); and for P3 3.0 mm (axial), 3.5 mm (MPR), 2.5 mm (centerline). Measurement time using centerline analysis was significantly shorter than for assessment by MPR. CONCLUSIONS Centerline analysis provides the least variable and fast diameter measurements in TEVAR patients with the same accuracy as the current reference standard MPR.
Collapse
Affiliation(s)
- M Müller-Eschner
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Ghatwary T, Karthikesalingam A, Patterson B, Hinchliffe R, Morgan R, Loftus I, Salem A, Thompson MM, Holt PJ. St George's Vascular Institute Protocol: An Accurate and Reproducible Methodology to Enable Comprehensive Characterization of Infrarenal Abdominal Aortic Aneurysm Morphology in Clinical and Research Applications. J Endovasc Ther 2012; 19:400-14. [DOI: 10.1583/11-3731mr.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
6
|
Saida T, Mori K, Sato F, Shindo M, Takahashi H, Takahashi N, Sakakibara Y, Minami M. Prospective intraindividual comparison of unenhanced magnetic resonance imaging vs contrast-enhanced computed tomography for the planning of endovascular abdominal aortic aneurysm repair. J Vasc Surg 2012; 55:679-87. [DOI: 10.1016/j.jvs.2011.09.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 09/26/2011] [Accepted: 09/26/2011] [Indexed: 11/17/2022]
|
7
|
Prospective Evaluation of High-Resolution MRI Using Gadofosveset for Stent-Graft Planning: Comparison With CT Angiography in 30 Patients. AJR Am J Roentgenol 2011; 197:1251-7. [DOI: 10.2214/ajr.10.6268] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
8
|
Labruto F, Blomqvist L, Swedenborg J. Imaging the Intraluminal Thrombus of Abdominal Aortic Aneurysms: Techniques, Findings, and Clinical Implications. J Vasc Interv Radiol 2011; 22:1069-75; quiz 1075. [DOI: 10.1016/j.jvir.2011.01.454] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 01/20/2011] [Accepted: 01/30/2011] [Indexed: 10/18/2022] Open
|
9
|
Michineau S, Dai J, Gervais M, Zidi M, Clowes AW, Becquemin JP, Michel JB, Allaire E. Aortic length changes during abdominal aortic aneurysm formation, expansion and stabilisation in a rat model. Eur J Vasc Endovasc Surg 2010; 40:468-74. [PMID: 20554458 DOI: 10.1016/j.ejvs.2010.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 05/05/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Determinants of extracellular matrix (ECM) destruction/reconstruction balance influencing abdominal aortic aneurysm (AAA) diameter may impact length. OBJECTIVE Document aortic lengthening, its correlation to diameter, and determine how treatments that impact diameter also affect length. METHODS Three hundred and fifty-five diameter and length measurements were performed in 308 rats during AAA formation, expansion and stabilisation in guinea pig aortas xenografted in rats. Impact of modulation of ECM destructive/reconstructive balance by endovascular Vascular Smooth Muscle Cell (VSMCs) seeding, TIMP-1, PAI-1 and TGF-beta1 overexpression on length has been assessed. RESULTS Length increased in correlation with diameter during formation (correlation coefficient (cc): 0.584, P<0.0001) and expansion (cc: 0.352, P=0.0055) of AAAs. Overexpression of TIMP-1 and PAI-1 decreased lengthening (P=0.02 and 0.014, respectively) demonstrating that elongation is driven by matrix metalloproteinases and their activation by the plasmin pathway. Overexpression of TGF-beta1 controlled length in formed AAAs (17.3 ± 9.6 vs. 5.9 ± 7.4mm, P=0.022), but not VSMC seeding, although both therapies efficiently prevented further diameter increase. Length and diameter correlation was lost after biotherapies. CONCLUSION Length increases in correlation with diameter during AAA formation and expansion, as a consequence of ECM injury driven by MMPs activated by the plasmin pathway. Correlation between length and diameter increases is not universally preserved.
Collapse
MESH Headings
- Analysis of Variance
- Animals
- Aorta, Abdominal/metabolism
- Aorta, Abdominal/pathology
- Aorta, Abdominal/surgery
- Aortic Aneurysm, Abdominal/metabolism
- Aortic Aneurysm, Abdominal/pathology
- Aortic Aneurysm, Abdominal/surgery
- Disease Models, Animal
- Extracellular Matrix/pathology
- Guinea Pigs
- Muscle, Smooth, Vascular/cytology
- Plasminogen Activator Inhibitor 1/metabolism
- Rats
- Statistics, Nonparametric
- Tissue Inhibitor of Metalloproteinase-1/metabolism
- Transforming Growth Factor beta1/metabolism
Collapse
Affiliation(s)
- S Michineau
- CNRS EAC 7054, Centre de Recherches Chirurgicales Dominique Chopin, University Paris, 12 Val de Marne, 8 Rue du Général Sarrail, 94010 Créteil Cedex, France
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Kauffmann C, Tang A, Dugas A, Therasse É, Oliva V, Soulez G. Clinical validation of a software for quantitative follow-up of abdominal aortic aneurysm maximal diameter and growth by CT angiography. Eur J Radiol 2009; 77:502-8. [PMID: 19962261 DOI: 10.1016/j.ejrad.2009.07.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 07/21/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare the reproducibility and accuracy of abdominal aortic aneurysm (AAA) maximal diameter (D-max) measurements using segmentation software, with manual measurement on double-oblique MPR as a reference standard. MATERIALS AND METHODS The local Ethics Committee approved this study and waived informed consent. Forty patients (33 men, 7 women; mean age, 72 years, range, 49-86 years) had previously undergone two CT angiography (CTA) studies within 16 ± 8 months for follow-up of AAA ≥ 35 mm without previous treatment. The 80 studies were segmented twice using the software to calculate reproducibility of automatic D-max calculation on 3D models. Three radiologists reviewed the 80 studies and manually measured D-max on double-oblique MPR projections. Intra-observer and inter-observer reproducibility were calculated by intraclass correlation coefficient (ICC). Systematic errors were evaluated by linear regression and Bland-Altman analyses. Differences in D-max growth were analyzed with a paired Student's t-test. RESULTS The ICC for intra-observer reproducibility of D-max measurement was 0.992 (≥ 0.987) for the software and 0.985 (≥ 0.974) and 0.969 (≥ 0.948) for two radiologists. Inter-observer reproducibility was 0.979 (0.954-0.984) for the three radiologists. Mean absolute difference between semi-automated and manual D-max measurements was estimated at 1.1 ± 0.9 mm and never exceeded 5mm. CONCLUSION Semi-automated software measurement of AAA D-max is reproducible, accurate, and requires minimal operator intervention.
Collapse
Affiliation(s)
- Claude Kauffmann
- Department of Medical Imaging, Hôpital Notre-Dame, Centre Hospitalier Universitaire de Montréal, 1560 Sherbrooke Est, Montréal, Québec, Canada H2L 4M1.
| | | | | | | | | | | |
Collapse
|
11
|
Lu TLC, Rizzo E, Marques-Vidal PM, Segesser LKV, Dehmeshki J, Qanadli SD. Variability of ascending aorta diameter measurements as assessed with electrocardiography-gated multidetector computerized tomography and computer assisted diagnosis software. Interact Cardiovasc Thorac Surg 2009; 10:217-21. [PMID: 19884165 DOI: 10.1510/icvts.2009.216275] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Recently, morphometric measurements of the ascending aorta have been done with ECG-gated multidector computerized tomography (MDCT) to help the development of future novel transcatheter therapies (TCT); nevertheless, the variability of such measurements remains unknown. Thirty patients referred for ECG-gated CT thoracic angiography were evaluated. Continuous reformations of the ascending aorta, perpendicular to the centerline, were obtained automatically with a commercially available computer aided diagnosis (CAD). Then measurements of the maximal diameter were done with the CAD and manually by two observers (separately). Measurements were repeated one month later. The Bland-Altman method, Spearman coefficients, and a Wilcoxon signed-rank test were used to evaluate the variability, the correlation, and the differences between observers. The interobserver variability for maximal diameter between the two observers was up to 1.2 mm with limits of agreement [-1.5, +0.9] mm; whereas the intraobserver limits were [-1.2, +1.0] mm for the first observer and [-0.8, +0.8] mm for the second observer. The intraobserver CAD variability was 0.8 mm. The correlation was good between observers and the CAD (0.980-0.986); however, significant differences do exist (P<0.001). The maximum variability observed was 1.2 mm and should be considered in reports of measurements of the ascending aorta. The CAD is as reproducible as an experienced reader.
Collapse
Affiliation(s)
- Tri-Linh Christian Lu
- Department of Radiology and Cardiovascular and Metabolic Diseases Center, CHUV - University of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | | | | | | | | | | |
Collapse
|
12
|
Ciura VA, Lee MJ, Schemmer DC. MRA: Current Applications in Body Vascular Imaging. Can Assoc Radiol J 2009; 60:133-42. [DOI: 10.1016/j.carj.2009.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Viesha A. Ciura
- Department of Diagnostic Imaging, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Mark J. Lee
- Department of Diagnostic Imaging, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Drew C. Schemmer
- Department of Diagnostic Imaging, Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Diagnostic Imaging, Royal Victoria Hospital, Barrie, Ontario, Canada
| |
Collapse
|
13
|
Centerline Analysis of Aortic CT Angiographic Examinations: Benefits and Limitations. AJR Am J Roentgenol 2009; 192:W255-63. [DOI: 10.2214/ajr.08.1488] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
14
|
Tozzi P, Marty B, Ruchat P, Ferrari E, Siniscalchi G, von Segesser LK. Endovascular Thoracic Aortic Aneurysm Repair without Angiography. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009. [DOI: 10.1177/155698450900400107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Piergiorgio Tozzi
- CardioVascular Surgery Department, Centre Hospitalier Universitaire Vaudois—CHUV, Lausanne, Switzerland
| | - Bettina Marty
- CardioVascular Surgery Department, Centre Hospitalier Universitaire Vaudois—CHUV, Lausanne, Switzerland
| | - Patrick Ruchat
- CardioVascular Surgery Department, Centre Hospitalier Universitaire Vaudois—CHUV, Lausanne, Switzerland
| | - Enrico Ferrari
- CardioVascular Surgery Department, Centre Hospitalier Universitaire Vaudois—CHUV, Lausanne, Switzerland
| | - Giuseppe Siniscalchi
- CardioVascular Surgery Department, Centre Hospitalier Universitaire Vaudois—CHUV, Lausanne, Switzerland
| | - Ludwig K. von Segesser
- CardioVascular Surgery Department, Centre Hospitalier Universitaire Vaudois—CHUV, Lausanne, Switzerland
| |
Collapse
|
15
|
Endovascular Thoracic Aortic Aneurysm Repair without Angiography. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2009; 4:32-5. [DOI: 10.1097/imi.0b013e3181987ef2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective Intravascular ultrasound (IVUS) generates high definition circumferential cross-sectional images and provides real-time readout of vascular dimensions, including visualization of vessel branches. We have used it as an alternative to angiography in the endovascular thoracic aneurysm repair work-up. Methods Out of consecutive 203 patients with descending thoracic aortic aneurysm, 89 (43.8%) received endovascular treatment [mean age, 68 ± 8 years; range, 29–82; male, 79 (88.7%); female, 10 (11.3%)] without using angiography during the endovascular procedure. IVUS (6 F, 12.5 MHz probe or 10 F 9 MHz) coupled with fluoroscopy for the placement of radiopaque markers was used for target site identification, landing zone measurement, device positioning, and assessment of endovascular repair. Results Hospital mortality was 4/89 (4.5%). Number of devices implanted in each patient was 1.2 (range, 1–3). X-ray exposure time was 12 ± 8 minutes. Median procedure time was 63 ± 20 minutes. Conversion to open surgery was necessary in one patient (1.1%) because of aortic dissection. In nine patients (10.1%) left subclavian artery was covered because of a short neck. Two patients (2.2%) had vascular access lesions and required surgical repair. One patient developed paraplegia (1.1%). Early endoleak was observed in eight patients (8.9%) and 4 (4.5%) required additional procedures (proximal or distal extensions). Late conversion was necessary in one patient (1.1%). Conclusions IVUS provides all information necessary for device selection, target site identification as well as safe and correct deployment of thoracic endoprostheses and makes periprocedural angiography unnecessary, thus avoiding the risk of renal failure because of contrast medium.
Collapse
|
16
|
Pineau S, Vidal V, Monnet O, Varoquaux A, Le Corroller T, Gaubert JY, Jacquier A, Bartoli JM, Moulin G. Indagini radiologiche preoperatorie in chirurgia vascolare. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1283-0801(07)70071-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
17
|
de Gracia MM, Rodríguez-Vigil B, Garzón-Möll G, Bravo-Soberón A, Sánchez-Almaraz C, Alvarez-Sala-Walther R. Correlation between the Measurement of Transverse Diameter in the Proximal Neck on Computed Tomography and on Aortography before Endovascular Treatment of Infrarenal Aortic Aneurysm. Ann Vasc Surg 2006; 20:488-95. [PMID: 16791456 DOI: 10.1007/s10016-006-9077-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Revised: 04/07/2006] [Accepted: 04/10/2006] [Indexed: 11/30/2022]
Abstract
The aim of this study was to determine the correlation between the measurement of transverse diameter of the proximal neck on computed tomographic angiography (CTA) and graduated catheter aortography in patients who are candidates for endovascular graft placement in order to replace, if both measurements are equivalent, aortography for CTA alone. Preoperative dual-slice CTA and graduated catheter aortography were performed in 35 consecutive patients with infrarenal aortic aneurysm within 10 days. Transverse proximal neck diameters were measured on a true axial section on CTA reconstructions and on aortographic images, always 6 mm distal from the most inferior main renal artery. Mean, median, and standard deviation were obtained and the measurements correlated for each patient using Pearson's correlation and linear regression analysis. A significant difference in proximal neck transverse diameter measurements was found between graduated catheter aortography and CTA in all cases. CTA values were a mean of 1.74 mm higher than aortography values. Pearson's correlation indicates a strong correlation between both techniques, and a regression equation determines the predictive value of aortography on the basis of CTA values. Estimation of the transverse diameter of the proximal neck on aortography on the basis of that obtained on CTA allows us to affirm that CTA could be used as the sole method for the preoperative selection of appropriate endograft size in patients with infrarenal aortic aneurysm.
Collapse
|
18
|
Keller D, Wildermuth S, Boehm T, Boskamp T, Mayer D, Schuster HL, Marincek B, Alkadhi H. CT angiography of peripheral arterial bypass grafts: Accuracy and time-effectiveness of quantitative image analysis with an automated software tool. Acad Radiol 2006; 13:610-20. [PMID: 16627202 DOI: 10.1016/j.acra.2006.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Revised: 01/11/2006] [Accepted: 01/11/2006] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES Qualitative analysis of computed tomography (CT) angiography data often is limited by intra- and interobserver variability. The purpose of this study was to evaluate the time-effectiveness and accuracy of a quantitative CT angiography data analysis using automated software in comparison with qualitative axial and coronal CT image reading in patients with peripheral bypass grafts. MATERIALS AND METHODS Twenty-eight patients with 33 saphenous bypass grafts underwent 4-channel (n = 21) and 16-channel (n = 7) CT angiography. Two readers evaluated in consensus the CT data qualitatively on axial and coronal reconstructions and with the software regarding the presence of graft stenoses, aneurysmal changes, and arteriovenous fistulas. The time for data analysis was taken and the accuracy was compared with the results from digital subtraction angiography (DSA). RESULTS No significant difference was present between data analysis time using axial and coronal CT images (4.9 +/- 1.5 minutes) and when using the software tool (5.5 +/- 1.4 minutes). Good (kappa = 0.652) to excellent (kappa = 1.000) intermodality agreement was present between qualitative and quantitative CT analysis regarding graft-related abnormalities. Sensitivity and specificity for diagnosing stenoses, aneurysms, and fistula did not differ significantly (P > .025) between qualitative CT image reading and the automated software tool. CONCLUSIONS CT angiography analysis of peripheral bypass grafts using an automated software tool is similar regarding time-effectiveness and accuracy when compared with qualitative CT data analysis on axial and coronal images. It may assist in determining the significance of an abnormality and can yield objective morphometric data of vessel calibers.
Collapse
Affiliation(s)
- Denise Keller
- Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Golzarian J, Valenti D. Endoleakage after endovascular treatment of abdominal aortic aneurysms: diagnosis, significance and treatment. Eur Radiol 2006; 16:2849-57. [PMID: 16607497 DOI: 10.1007/s00330-005-0129-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Revised: 11/23/2005] [Accepted: 12/13/2005] [Indexed: 11/28/2022]
Abstract
Endoleak, also called leakage, leak and Perigraft leak, is a major complication and its persistence represents a failure of endovascular aortic aneurysm repair. Its detection and treatment is therefore of primary importance, since endoleak can be associated with pressurization (increase in pressure) of the sac, resulting in expansion and rupture of the aneurysm. The aim of this paper is to discuss the definition, significance, diagnosis and different options to treat endoleak.
Collapse
Affiliation(s)
- Jafar Golzarian
- University of Iowa Heath Care, University of Iowa, 200 Hawkins Drive, Iowa 52242, USA.
| | | |
Collapse
|
20
|
Atar E, Belenky A, Hadad M, Ranany E, Baytner S, Bachar GN. MR Angiography for Abdominal and Thoracic Aortic Aneurysms: Assessment Before Endovascular Repair in Patients with Impaired Renal Function. AJR Am J Roentgenol 2006; 186:386-93. [PMID: 16423943 DOI: 10.2214/ajr.04.0449] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of the study was to establish the feasibility of using MR angiography as the sole imaging technique before endovascular repair of abdominal or thoracic aortic aneurysms and to compare preprocedural measurements by MR angiography and digital subtraction angiography in patients with impaired renal function. CONCLUSION MR angiography appears to be effective and reliable for use as the sole imaging method before endovascular repair of aortic aneurysms in patients with renal impairment.
Collapse
Affiliation(s)
- Eli Atar
- Department of Radiology, Interventional Radiology Unit, Rabin Medical Center, Beilinson Campus, Petah-Tiqva 49100, Israel
| | | | | | | | | | | |
Collapse
|
21
|
Magnetic Resonance Imaging. Vasc Med 2006. [DOI: 10.1016/b978-0-7216-0284-4.50017-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
22
|
Abbara S, Cury RC, Nieman K, Reddy V, Moselewski F, Schmidt S, Ferencik M, Hoffmann U, Brady TJ, Achenbach S. Noninvasive evaluation of cardiac veins with 16-MDCT angiography. AJR Am J Roentgenol 2005; 185:1001-6. [PMID: 16177423 DOI: 10.2214/ajr.04.1382] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Anatomic mapping of the cardiac veins is important to guide transvenous therapeutic procedures such as biventricular pacing. As an alternative to invasive venography, we studied the feasibility of MDCT of the cardiac venous anatomy. CONCLUSION Cardiac venous anatomy is variable. MDCT is a noninvasive method that allows detailed imaging of the cardiac venous anatomy, including small cardiac veins and thebesian valves. Therefore, cardiac MDCT may be a valuable tool for guiding procedures that involve the cardiac venous system.
Collapse
Affiliation(s)
- Suhny Abbara
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, CIMIT, 100 Charles River Plaza, Ste. 400, Boston, MA 02114, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Hyodoh H, Katagiri Y, Sakai T, Hyodoh K, Akiba H, Hareyama M. Creation of individual ideally shaped stents using multi-slice CT: in vitro results from the semi-automatic virtual stent (SAVS) designer. Eur Radiol 2005; 15:1623-8. [PMID: 15761717 DOI: 10.1007/s00330-004-2587-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2004] [Revised: 11/01/2004] [Accepted: 11/08/2004] [Indexed: 10/25/2022]
Abstract
To plan stent-grafting for thoracic aortic aneurysm with complicated morphology, we created a virtual stent-grafting program [Semi Automatic Virtual Stent (SAVS) designer] using three-dimensional CT data. The usefulness of the SAVS designer was evaluated by measurement of transformed anatomical and straight stents. Curved model images (source, multi-planer reconstruction and volume rendering) were created, and a hollow virtual stent was produced by the SAVS designer. A straight Nitinol stent was transformed to match the curved configuration of the virtual stent. The accuracy of the anatomical stent was evaluated by experimental strain phantom studies in comparison with the straight stent. Mean separation length was 0 mm in the anatomical stent [22 mm outer diameter (OD)] and 5 mm in the straight stent (22 mm OD). The straight stent strain voltage was four times that of the anatomical stent at the stent end. The anatomical stent is useful because it fits the curved structure of the aorta and reduces the strain force compared to the straight stent. The SAVS designer can help to design and produce the anatomical stent.
Collapse
Affiliation(s)
- Hideki Hyodoh
- Department of Radiology, Sapporo Medical University, S-1 W-16 Chuo-ku, Sapporo, 060-8543, Japan.
| | | | | | | | | | | |
Collapse
|
24
|
Hellinger JC. Endovascular Repair of Thoracic and Abdominal Aortic Aneurysms: Pre- and Postprocedural Imaging. Tech Vasc Interv Radiol 2005; 8:2-15. [PMID: 16098932 DOI: 10.1053/j.tvir.2005.05.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endovascular repair of thoracic and abdominal aortic aneurysms is a safe alternative to conventional open surgical repair. Clinical success, however, is highly dependent on patient selection. Diagnostic vascular imaging has an essential role for this selection process. Following endovascular aneurysm repair (EVAR), patients require long-term surveillance and again vascular imaging serves an integral function. This article reviews EVAR selection criteria and post-EVAR assessment and then discusses the imaging modalities used to evaluate these patients, namely multi-detector-row computed tomographic angiography, magnetic resonance imaging/angiography, duplex ultrasonography, and catheter angiography.
Collapse
Affiliation(s)
- Jeffrey C Hellinger
- Department of Radiology, Stanford University Medical Center, Stanford, CA 94305, USA.
| |
Collapse
|
25
|
Bourlet P, Garcier JM, Alfidja A, Lipiecka E, Chahid T, Privat C, Ravel A, Boyer L. Angioscanner hélicoïdal de l’aorte abdominale. ACTA ACUST UNITED AC 2005; 86:13-28. [PMID: 15785413 DOI: 10.1016/s0221-0363(05)81318-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose was to illustrate that single or multirow spiral CT angiography has become the main modality for the examination of the abdominal aorta. Our multidisciplinary group investigates weekly 15 abdominal aortas, with a single slice spiral CT since 1995, and a 4 row detector spiral CT since 1999. CT scans protocols and parameters optimization for the 2 CT systems are described. Indications and results of CT to investigate the various abdominal aortic diseases are illustrated and discussed: aneurisms (pretherapeutic staging, selection of indications of endovascular stent-grafting); obstructive aorto-arteriopathies (pretherapeutic staging, follow up after endovascular revascularization); dissection (diagnosis, pretherapeutic staging, follow up); inflammatory diseases; normal patterns and principal complications after surgery. Situations where multislice CT is superior to single slice CT and compared advantages of MRI are discussed. CT is at the present time the main technique to image abdominal aorta. Multislice CT is especially interesting to explore the whole aorta, poly traumatisms, and to plan and follow up endovascular treatments.
Collapse
Affiliation(s)
- P Bourlet
- Service de Radiologie B Viscérale et Vasculaire, CHU Montpied, BP 69, 63003 Clermont-Ferrand cedex, France
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Neri E, Bargellini I, Rieger M, Giachetti A, Vignali C, Tuveri M, Jaschke W, Bartolozzi C. Abdominal aortic aneurysms: virtual imaging and analysis through a remote web server. Eur Radiol 2004; 15:348-52. [PMID: 15503043 DOI: 10.1007/s00330-004-2500-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Revised: 08/03/2004] [Accepted: 08/23/2004] [Indexed: 10/26/2022]
Abstract
The study describes the application of a web-based software in the planning of the endovascular treatment of abdominal aortic aneurysms (AAA). The software has been developed in the framework of a 2-year research project called Aneurysm QUAntification Through an Internet Collaborative System (AQUATICS); it allows to manage remotely Virtual Reality Modeling Language (VRML) models of the abdominal aorta, derived from multirow computed tomography angiography (CTA) data sets, and to obtain measurements of diameters, angles and centerline lengths. To test the reliability of measurements, two radiologists performed a detailed analysis of multiple 3D models generated from a synthetic phantom, mimicking an AAA. The system was tested on 30 patients with AAA; CTA data sets were mailed and the time required for segmentation and measurement were collected for each case. The Bland-Altman plot analysis showed that the mean intra- and inter-observer differences in measures on phantoms were clinically acceptable. The mean time required for segmentation was 1 h (range 45-120 min). The mean time required for measurements on the web was 7 min (range 4-11 min). The AQUATICS web server may provide a rapid, standardized and accurate tool for the evaluation of AAA prior to the endovascular treatment.
Collapse
Affiliation(s)
- Emanuele Neri
- Diagnostic and Interventional Radiology, Department of Oncology, Transplants, and Advanced Technologies in Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Diehm N, Herrmann P, Dinkel HP. Multidetector CT Angiography Versus Digital Subtraction Angiography for Aortoiliac Length Measurements Prior to Endovascular AAA Repair. J Endovasc Ther 2004; 11:527-34. [PMID: 15482025 DOI: 10.1583/03-1172.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess observer variation between calibrated-catheter digital subtraction angiography (DSA) and software-enhanced multidetector computed tomography angiography (CTA) in measuring vessel length prior to endovascular aortic aneurysm repair (EVAR). METHODS Thirty patients (25 men; mean age 65 years, range 61-85) scheduled for EVAR underwent CTA in 4x2-mm collimation using advanced vessel analysis software. CTA measurements were performed twice by 2 blinded readers in random order with at least a 4-week interval between readings. Nine patients were found unsuitable for endovascular repair after the CTA, so DSA was performed in 21 patients for morphometric evaluation of the abdominal aorta and the iliac arteries. The following segments were measured: H1 (aneurysm neck), H2 (lower renal artery to distal aspect of the aneurysm), H3 (lower renal artery to aortic bifurcation), and H4a/H4b (lower renal artery to iliac bifurcations). Length measurements on DSA were made by (1) following the catheter path in the aortic lumen and (2) dividing tortuous vessel anatomy into segments and measuring each segment along an idealized centerline. Addition of the various segments allowed comparison with data obtained from CTA measurements. RESULTS CTA was performed with good intraobserver agreement for all length parameters except H3 in reader 2 (p<0.05). While good interobserver agreement was demonstrated for CTA over long aortoiliac distances (H4a, H4b), higher interobserver agreement was obtained with DSA for shorter segments (H1, H2). Considerable differences were observed between CTA and DSA for the lengths H2 and H4b. CONCLUSIONS CTA produces better intra and interobserver correlations in measuring vessel length than DSA. It has the potential to replace DSA as an imaging method before EVAR.
Collapse
Affiliation(s)
- Nicolas Diehm
- Institute of Diagnostic Radiology, Department of Radiology, Inselspital, University Hospital of Bern, Switzerland
| | | | | |
Collapse
|
28
|
Krämer SC, Wall A, Maintz D, Bachmann R, Kugel H, Heindel W. 3.0 Tesla Magnetic Resonance Angiography of Endovascular Aortic Stent Grafts. Invest Radiol 2004; 39:413-7. [PMID: 15194912 DOI: 10.1097/01.rli.0000129470.63758.c1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVES This study evaluated different stent grafts by 3 T magnetic resonance angiography (MRA) with respect to lumen visibility, susceptibility-induced signal loss, and type of stent artifacts compared with 1.5 T MRA in a phantom model. METHODS Six different stent-grafts (tube: n = 3, bifurcated: n = 3) were evaluated by 3 T and 1.5 T MRA using a tube phantom. MRA was performed using T1-weighted sequences at both systems with comparable parameters (3T: TR 5.4/TE 2.0/FA 30 degrees, 1.5 T: TR 6.2/TE 2.2/FA 30 degrees). A blind study of the image quality, including artifacts, was performed by 3 radiologists. Furthermore, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) values were calculated. Statistical analysis was performed with Student's t test (P < 0.05). RESULTS One Elgiloy stent graft showed almost a complete intraluminal signal loss at 1.5 and 3 T. All other models could be evaluated by both systems by MRA, resulting in a favorable lumen visibility (score: 1) for prostheses made of nitinol. Scores for overall image quality and artifacts were the same for both MR systems. SNR and CNR values of the stented part of the vessel phantom increased from 320 +/- 33 to 618 +/- 40 and from 306 +/- 34 to 596 +/- 40 at 3 T when compared with 1.5 T, resulting in a significant signal gain of 93% at the higher field strength. CONCLUSIONS 3 Tesla MRA of aortic stent grafts in a phantom model demonstrates an increase in SNR and CNR when compared with 1.5 T. However, the magnitude of imaging artifacts as well as coherent intraluminal signal loss within the stent does not increase equally in both MR systems.
Collapse
Affiliation(s)
- Stefan C Krämer
- Institut fur Klinische Radiologie, Rontgendiagnostik, Universitatsklinikum, Munster, Germany.
| | | | | | | | | | | |
Collapse
|
29
|
Beebe HG, Kritpracha B. Computed tomography scanning for endograft planning: evolving toward three-dimensional, single source imaging. Semin Vasc Surg 2004; 17:126-34. [PMID: 15185178 DOI: 10.1053/j.semvascsurg.2004.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
One of the most fundamental differences between open surgical repair of aortic aneurysms and treatment by endograft exclusion is the dependency on imaging for all critically important aspects of the endovascular approach. Patient selection and preprocedure planning for device selection and sizing depend on imaging. Computed tomography (CT) scanning for endograft planning is capable of providing accurate and complete measurement data. There are problems with diameter, length, and angulation measurement when using conventional two-dimensional (2D) axial CT images that can be partly overcome by expert interpretation. However, when computerized 3D programs that include easy-to-use measurement tools process CT data, the problems of 2D CT scan data are relieved. In addition, virtual simulation of various endograft choices can be modeled within computerized renderings of patient-specific anatomy that allow testing of alternatives and provide an intuitive understanding during the planning phase.
Collapse
Affiliation(s)
- Hugh G Beebe
- Caroline Jobst Vascular Imaging Laboratory, Jobst Vascular Center, Toledo, OH 43606, USA
| | | |
Collapse
|
30
|
Izzillo R, Cassagnes L, Boutekadjirt R, Garcier JM, Cluzel P, Boyer L. Quand, comment et pourquoi réaliser une imagerie d’un anévrisme de l’aorte abdominale ? ACTA ACUST UNITED AC 2004; 85:870-82. [PMID: 15243362 DOI: 10.1016/s0221-0363(04)97693-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Usually atherosclerotic in origin, aneurysms of the abdominal aorta (AAA) tend to involve the infrarenal aorta. Their biphasic exponential growth pattern, initially slow then accelerated, results in a risk of rupture. Surgical management is recommended for aneurysm diameters of 45-50mm or for growth rates more than 5mm in 6 Months. Imaging is useful for detection and follow-up of nonsurgical aneurysms, presurgical evaluation of aneurysms, and postsurgical follow-up. Frequently asymptomatic, AAA frequently is an incidental finding at the time of abdominal US. The size of the aneurysm sac, the presence of a neck and the size of the iliac arteries are assessed at the time of initial US detection. US is sufficient for follow-up of small aneurysms. Cross sectional imaging evaluation is necessary when surgery is contemplated. Readily available, multidetector row CT scanners with advanced image post-processing capabilities provide all the necessary information prior to surgical or endovascular management: evaluation of the aneurysm sac and neck, iliac and visceral arteries, and adjacent organs. Angiography with graduated catheters remains sometimes indicated. MR angiography provides results similar to CT but is less readily available and is usually reserved for patients with contraindication to iodinated contrast material. While follow-up imaging after surgical management is seldom performed, it is mandatory after endovascular management and includes KUB, Doppler US and CT or MR angiography.
Collapse
Affiliation(s)
- R Izzillo
- Service de Radiologie, La Pitié Salpétrière, Paris
| | | | | | | | | | | |
Collapse
|