The accuracy of computed tomography central luminal line measurements in quantifying stent graft migration Andrew England, MSc, Marta García-Fiñana,

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Presentation transcript:

The accuracy of computed tomography central luminal line measurements in quantifying stent graft migration Andrew England, MSc, Marta García-Fiñana, PhD, Thien V. How, PhD, S. Rao Vallabhaneni, MD, FRCS, Richard G. McWilliams, FRCS, FRCR Journal of Vascular Surgery Volume 55, Issue 4, Pages 895-905 (April 2012) DOI: 10.1016/j.jvs.2011.10.083 Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 1 Central luminal line (CLL) images with corresponding oblique axial reformats demonstrate the technique used to record stent graft position against the superior mesenteric artery (L1) and right renal artery (L2). The two lines perpendicular to the CLL correspond to the center of the reformatted images used to confirm the locations for the two measurement positions. Journal of Vascular Surgery 2012 55, 895-905DOI: (10.1016/j.jvs.2011.10.083) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 2 A clinical central luminal line (CLL) measurement taken at the proximal landing zone of the stent graft. The first axial reformatted image, where at least two stents struts were visible (dotted line), was considered indicative of the proximal stent position. The first reformatted slice where there was a clear space between the superior mesenteric artery (SMA) and the aortic wall was considered the inferior border of the reference vessel (solid line). Lines perpendicular to the CLL demonstrate the projection of each oblique reformat and indicate the central point within each reconstructed slice. Journal of Vascular Surgery 2012 55, 895-905DOI: (10.1016/j.jvs.2011.10.083) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 3 A clinical central luminal line (CLL) measurement taken at the distal landing zone of the stent graft. The position of the distal stent graft is recorded relative to the bifurcation of the common iliac artery. The first axial reformatted image where at least two stents struts were visible was considered indicative of the distal stent position (dotted line). The first reformatted slice where there was a clear space between the external iliac artery and the internal iliac artery was considered as the iliac bifurcation (solid line). Lines perpendicular to the CLL demonstrate the projection of each oblique reformat and indicate the central point within each reconstructed slice. Journal of Vascular Surgery 2012 55, 895-905DOI: (10.1016/j.jvs.2011.10.083) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 4 Bland Altman plots displaying the (A-C) bias and (D-F) variability for the central luminal line (CLL) assessment of stent graft migration in aortic phantoms. SD, Standard deviation. A-C, The CLL bias for each observer was determined by calculating the difference between the actual stent graft migration and the computed tomography (CT)-determined stent graft migration using measurement set 1. Limits of agreement (±1.96 SDs) were also plotted so delineated the extremes of any bias (outer solid lines). D, Intraobserver variability refers to the differences between repeat measurements of stent graft migration for the same observer (within observer). The difference between the two measurements has been plotted against the mean of the two paired measurements for observer one. E and F, Interobserver variability refers to the differences in migration measurements between observer 1 and observer 2 and observers 1 and 3 (between observers) plotted against the mean of the two respective measurements. All calculations for interobserver variability were based on measurement set 1 for each observer. For simplicity, the migration values illustrated are based on average values of the superior mesenteric artery (L1) and the right renal artery (L2). Journal of Vascular Surgery 2012 55, 895-905DOI: (10.1016/j.jvs.2011.10.083) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 5 Bland-Altman plots display the central luminal line (CLL) (A) intraobserver and (B) interobserver variability for the assessment of stent graft migration when using clinical computed tomography scans. Intraobserver variability refers to the differences between repeat measurements of stent graft migration for the same observer (within observer). Interobserver variability refers to the differences between migration measurements (measurement sets 1) for observer 1 compared with observer 2 (between observers). The intraobserver and interobserver differences have both been plotted against the respective mean of the two comparative measurements. Limits of agreement (±1.96 standard deviations [SD]) have also been plotted to delineate the extremes of any variability (outer solid lines). The migration values illustrated are based on average values of both proximal and distal migrations. Journal of Vascular Surgery 2012 55, 895-905DOI: (10.1016/j.jvs.2011.10.083) Copyright © 2012 Society for Vascular Surgery Terms and Conditions