Lydia Dux-Santoy1, Jose F Rodríguez-Palomares2,3,4,5, Gisela Teixidó-Turà1,6,7, Aroa Ruiz-Muñoz1,6, Guillem Casas7, Filipa Valente7, Maria Luz Servato7, Laura Galian-Gay7, Laura Gutiérrez7, Teresa González-Alujas7, Rubén Fernández-Galera7, Arturo Evangelista1,6,7,8, Ignacio Ferreira-González9,10,11,12, Andrea Guala1,6. 1. Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. 2. Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. jfrodriguezpalomares@gmail.com. 3. CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain. jfrodriguezpalomares@gmail.com. 4. Department of Cardiology, Hospital Universitari Vall D'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain. jfrodriguezpalomares@gmail.com. 5. Universitat Autònoma de Barcelona, Bellaterra, Spain. jfrodriguezpalomares@gmail.com. 6. CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain. 7. Department of Cardiology, Hospital Universitari Vall D'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain. 8. Instituto del Corazón. Quirónsalud-Teknon, Barcelona, Spain. 9. Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. iferreir@vhebron.net. 10. Department of Cardiology, Hospital Universitari Vall D'Hebron, Paseo Vall d'Hebron 119-129, 08035, Barcelona, Spain. iferreir@vhebron.net. 11. Universitat Autònoma de Barcelona, Bellaterra, Spain. iferreir@vhebron.net. 12. CIBER de Epidemiología y Salud Pública, CIBERESP, Instituto de Salud Carlos III, Madrid, Spain. iferreir@vhebron.net.
Abstract
OBJECTIVES: Manual assessment of aortic diameters on double-oblique reformatted computed tomography angiograms (CTA) is considered the current standard, although the reproducibility for growth rates has not been reported. Deformable registration of CTA has been proposed to provide 3D aortic diameters and growth maps, but validation is lacking. This study aimed to quantify accuracy and inter-observer reproducibility of registration-based and manual assessment of aortic diameters and growth rates. METHODS: Forty patients with ≥ 2 CTA acquired at least 6 months apart were included. Aortic diameters and growth rate were obtained in the aortic root and the entire thoracic aorta using deformable image registration by two independent observers, and compared with the current standard at typical anatomical landmarks. RESULTS: Compared with manual assessment, the registration-based technique presented low bias (0.46 mm), excellent agreement (ICC = 0.99), and similar inter-observer reproducibility (ICC = 0.99 for both) for aortic diameters; and low bias (0.10 mm/year), good agreement (ICC = 0.82), and much higher inter-observer reproducibility for growth rates (root: ICC = 0.96 vs 0.68; thoracic aorta: ICC = 0.96 vs 0.80). Registration-based growth rate reproducibility over a 6-month-long follow-up was similar to that obtained by manual assessment after 2.7 years (LoA = [- 0.01, 0.33] vs [- 0.13, 0.21] mm/year, respectively). Mapping of diameter and growth rate was highly reproducible (ICC > 0.9) in the whole thoracic aorta. CONCLUSIONS: Registration-based assessment of aortic dilation on CTA is accurate and substantially more reproducible than the current standard, even at follow-up as short as 6 months, and provides robust 3D mapping of aortic diameters and growth rates beyond the pre-established anatomic landmarks. KEY POINTS: • Registration-based semi-automatic assessment of progressive aortic dilation on CTA is accurate and substantially more reproducible than the current standard. • The registration-based technique allows robust growth rate assessment at follow-up as short as 6 months, with a similar reproducibility to that obtained by manual assessment at around 3 years. • The use of image registration provides robust 3D mapping of aortic diameters and growth rates beyond the pre-established anatomic landmarks.
OBJECTIVES: Manual assessment of aortic diameters on double-oblique reformatted computed tomography angiograms (CTA) is considered the current standard, although the reproducibility for growth rates has not been reported. Deformable registration of CTA has been proposed to provide 3D aortic diameters and growth maps, but validation is lacking. This study aimed to quantify accuracy and inter-observer reproducibility of registration-based and manual assessment of aortic diameters and growth rates. METHODS: Forty patients with ≥ 2 CTA acquired at least 6 months apart were included. Aortic diameters and growth rate were obtained in the aortic root and the entire thoracic aorta using deformable image registration by two independent observers, and compared with the current standard at typical anatomical landmarks. RESULTS: Compared with manual assessment, the registration-based technique presented low bias (0.46 mm), excellent agreement (ICC = 0.99), and similar inter-observer reproducibility (ICC = 0.99 for both) for aortic diameters; and low bias (0.10 mm/year), good agreement (ICC = 0.82), and much higher inter-observer reproducibility for growth rates (root: ICC = 0.96 vs 0.68; thoracic aorta: ICC = 0.96 vs 0.80). Registration-based growth rate reproducibility over a 6-month-long follow-up was similar to that obtained by manual assessment after 2.7 years (LoA = [- 0.01, 0.33] vs [- 0.13, 0.21] mm/year, respectively). Mapping of diameter and growth rate was highly reproducible (ICC > 0.9) in the whole thoracic aorta. CONCLUSIONS: Registration-based assessment of aortic dilation on CTA is accurate and substantially more reproducible than the current standard, even at follow-up as short as 6 months, and provides robust 3D mapping of aortic diameters and growth rates beyond the pre-established anatomic landmarks. KEY POINTS: • Registration-based semi-automatic assessment of progressive aortic dilation on CTA is accurate and substantially more reproducible than the current standard. • The registration-based technique allows robust growth rate assessment at follow-up as short as 6 months, with a similar reproducibility to that obtained by manual assessment at around 3 years. • The use of image registration provides robust 3D mapping of aortic diameters and growth rates beyond the pre-established anatomic landmarks.
Authors: Loren F Hiratzka; George L Bakris; Joshua A Beckman; Robert M Bersin; Vincent F Carr; Donald E Casey; Kim A Eagle; Luke K Hermann; Eric M Isselbacher; Ella A Kazerooni; Nicholas T Kouchoukos; Bruce W Lytle; Dianna M Milewicz; David L Reich; Souvik Sen; Julie A Shinn; Lars G Svensson; David M Williams Journal: Circulation Date: 2010-03-16 Impact factor: 29.690