Impact of Image Analysis Methodology on Diagnostic and Surgical Classification of Patients With Thoracic Aortic Aneurysms

Mendoza, Dorinna D.; Kochar, Minisha; Devereux, Richard B.; Basson, Craig T.; Min, James K.; Holmes, Kathryn W.; Dietz, Harry C.; Milewicz, Dianna M.; LeMaire, Scott A.; Pyeritz, Reed E.; Bavaria, Joseph E.; Maslen, Cheryl L.; Song, Howard K.; Kröner, Barbara; Eagle, Kim A.; Weinsaft, Jonathan W.

doi:10.1016/j.athoracsur.2011.03.130

Cited by 67 publications

(46 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…(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: 96%

See 1 more Smart Citation

The Need for Standardized Methods for Measuring the Aorta

Asch

Yuriditsky

Prakash³

et al. 2016

JACC: Cardiovascular Imaging

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 96%

“…Measurements by CT and MRI were analyzed with a double-oblique technique. (8) The iCORE analyzed only native aortic segments, excluding any grafted measurements.…”

Section: Methodsmentioning

confidence: 99%

The Need for Standardized Methods for Measuring the Aorta

Asch

Yuriditsky

Prakash³

et al. 2016

JACC: Cardiovascular Imaging

Self Cite

View full text Add to dashboard Cite

show abstract

“…Since the ascending aorta is not totally vertical and may be asymmetrical, aorta size may be overestimated using axial planes. An interesting study of GenTAC showed that aortic size measured by CT differed significantly between axial and double-oblique planes at all locations, with the magnitude greatest by axial measurement at the sinotubular junction (4.8±1.1 vs 4.0±1.0 m, p<0.001) 18. In addition, regarding established surgical cut-offs for prophylactic repair of ascending aortic aneurysms, the use of axial dimensions resulted in a nearly a twofold rise in surgical indications than double obliquity (44% vs 24%).…”

Section: Aortic Sizementioning

confidence: 97%

Imaging aortic aneurysmal disease

Evangelista

2014

Heart

View full text Add to dashboard Cite

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.

show abstract

“…Measures performed over axial planes comparing with double oblique planes may overestimate the real diameter because of aortic tortuosity, causing significantly higher results, which can have an impact on the diagnosis and surgical management of the patient (10).…”

Section: Editorialmentioning

confidence: 99%