Jasper W. van Keulen, MD, Frans L. Moll, MD, PhD, Jip L

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Presentation transcript:

Validation of a new standardized method to measure proximal aneurysm neck angulation Jasper W. van Keulen, MD, Frans L. Moll, MD, PhD, Jip L. Tolenaar, MD, Hence J.M. Verhagen, MD, PhD, Joost A. van Herwaarden, MD, PhD Journal of Vascular Surgery Volume 51, Issue 4, Pages 821-828 (April 2010) DOI: 10.1016/j.jvs.2009.10.114 Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 1 A, An anteroposterior view of the aorta shows the measurement of the infrarenal aortic angulation. B, A plane perpendicular to the center lumen line (CLL) in the middle of the infrarenal angle is added. C, The exact same angle is measured as in Panel A, but now with a view perpendicular to the CLL in the middle of the angle (indicated by the yellow line perpendicular to the CLL). Note the more severe angle measured on the right. The difference is caused by the horizontal movement of the aorta, which is unnoticed because of aortic overlap in Panel A. Thus, the angle measured on the left is an underestimation. Journal of Vascular Surgery 2010 51, 821-828DOI: (10.1016/j.jvs.2009.10.114) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 2 The influence is shown of asymmetric widening of the aorta on aortic angles. The angle of the inner curvature is more severe than the angle of the outer curvature. Journal of Vascular Surgery 2010 51, 821-828DOI: (10.1016/j.jvs.2009.10.114) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 3 The consecutive steps for aortic angle measurements are shown. A, The construction of the center lumen line (CLL) is performed semi-automatically. CLL spline points (red points) are checked and can be corrected manually, if necessary. B, An anteroposterior view of the aorta with a plane perpendicular to the middle of the infrarenal angle is seen. The arrow indicates that the three-dimensional reconstruction should be rotated along the green line to obtain a view perpendicular to the middle of the infrarenal angle. C, A view perpendicular to the middle of the infrarenal angle is seen (indicated by the yellow line perpendicular to the CLL). The arrow indicates that the three-dimensional reconstruction should be rotated 360° around the green line for measurement of the aortic angle. D, Measurement of the most severe angle over the 360° in the middle of the angle with the use of electronic callipers. Journal of Vascular Surgery 2010 51, 821-828DOI: (10.1016/j.jvs.2009.10.114) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 4 Three-dimensional reconstructions of the aorta are shown. An aortic center lumen line (CLL) is created (yellow line) in all reconstructions. The view in all reconstructions is perpendicular to the middle of the infrarenal angle (indicated by the yellow line perpendicular to the CLL). A, B and C, Note the differences in angle while the three-dimensional reconstruction is turned 360° around this point. The most severe angle of the CLL is noted as the true angle. Journal of Vascular Surgery 2010 51, 821-828DOI: (10.1016/j.jvs.2009.10.114) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 5 The angle between the longitudinal axis of the suprarenal aorta and the longitudinal axis of the abdominal aortic aneurysm (AAA) neck (α) and the angle between the longitudinal axis of AAA neck and the longitudinal axis of the AAA sac (β) are shown. Journal of Vascular Surgery 2010 51, 821-828DOI: (10.1016/j.jvs.2009.10.114) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 6 Bland and Altman plots show observer variability of both angles. The mean of pairs is plotted against the difference of pairs. The mean difference is close to zero, and the limits of agreement, set as 1.96 standard deviations (SD), are acceptable. Journal of Vascular Surgery 2010 51, 821-828DOI: (10.1016/j.jvs.2009.10.114) Copyright © 2010 Society for Vascular Surgery Terms and Conditions

Fig 7 Bland and Altman plots show interobserver variability of both angles. The mean of pairs is plotted against the difference of pairs. The mean difference is close to zero, and the limits of agreement, set as 1.96 standard deviations (SD), are acceptable. Journal of Vascular Surgery 2010 51, 821-828DOI: (10.1016/j.jvs.2009.10.114) Copyright © 2010 Society for Vascular Surgery Terms and Conditions