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Review
. 2021 Jan 8;5(1):zraa041.
doi: 10.1093/bjsopen/zraa041.

Systematic approach towards reliable estimation of abdominal aortic aneurysm size by ultrasound imaging and CT

S M Tomee  1 , C A Meijer  2   3 , D A Kies  2 , S le Cessie  4   5 , M N J M Wasser  2 , J Golledge  6   7 , J F Hamming  1 , J H N Lindeman  1
Affiliations
Review

Systematic approach towards reliable estimation of abdominal aortic aneurysm size by ultrasound imaging and CT

S M Tomee et al. BJS Open. .

Abstract

Background: The management of abdominal aortic aneurysm (AAA) is fully dictated by AAA size, but there are no uniform measurement guidelines, and systematic differences exist between ultrasound- and CT-based size estimation. The aim of this study was to devise a uniform ultrasound acquisition and measurement protocol, and to test whether harmonization of ultrasound and CT readings is feasible.

Methods: A literature review was undertaken to evaluate evidence for ultrasound-based measurement of AAA. A protocol for measuring AAA was then developed, and intraobserver and interobserver reproducibility was tested. Finally, agreement between ultrasound readings and CT-based AAA diameters was evaluated. This was an observational study of patients with a small AAA who participated in two pharmaceutical intervention trials.

Results: Based on a literature review, an ultrasound acquisition and reading protocol was devised. Evaluation of the protocol showed an intraobserver repeatability of 1.6 mm (2s.d.) and an interobserver intraclass correlation coefficient (ICC) of 0.97. Comparison of protocolled ultrasound readings and local CT readings indicated a good correlation (r = 0.81), but a systematic +4.1-mm difference for CT. Harmonized size readings for ultrasound imaging and CT increased the correlation (r = 0.91) and reduced the systematic difference to +1.8 mm by CT. Interobserver reproducibility of protocolized CT measurements showed an ICC of 0.94 for the inner-to-inner method and 0.96 for the outer-to-outer method.

Conclusion: The absence of harmonized size acquisition and reading guidelines results in overtreatment and undertreatment of patients with AAA. This can be avoided by the implementation of standardized ultrasound acquisition and a harmonized reading protocol for ultrasound- and CT-based readings.

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Figures

Fig. 1
Fig. 1
PRISMA diagram for the literature review AAA, abdominal aortic aneurysm.
Fig. 2
Fig. 2
Illustrated measurement guide to include three-dimensional information on the point of maximum dilatation Maximum diameter should be corroborated in longitudinal and axial planes to avoid both overestimation and underestimation due to parallax error. See Table 2 for an explanation of panels a–e.
Fig. 3
Fig. 3
Scatterplot of protocolled ultrasound central abdominal aortic aneurysm readings and local CT readings n = 35; mean difference 4.1 mm (P < 0.001, linear regression analysis).
Fig. 4
Fig. 4
Scatterplot of ultrasound central anterior–posterior reading and CT central anterior–posterior reading, inner-to-inner wall n = 35; mean difference 1.8 mm (P < 0.001, linear regression analysis).
See this image and copyright information in PMC

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