Measuring of Abdominal Aortic Aneurysm with Three-Dimensional Computed Tomography Reconstruction before Endovascular Aortic Aneurysm Repair

ABSTRACT

PURPOSE: Conventional computed tomography (CT) is the gold standard method for case planning for endovascular aortic aneurysm repair (EVAR). However, aortography with a marking catheter is needed for measuring the actual length of an aneurysm. With advances in imaging technology, a 3-dimensional (3D) workstation can obviate the need for the aortography. The objective of this study was to determine whether a 3D workstation could obviate the need for aortography for EVAR. MATERIALS AND METHODS: One vascular surgeon and 1 interventional radiologist retrospectively assessed axial CT scans and reformatted the 3D CT scans by using the iNtuition workstation (TeraRecon Inc., San Mateo, CA, USA) for 25 patients who underwent EVAR. Four measurements of diameter and length were obtained from each modality. The actual length of an aneurysm for the proper graft was decided by 2 observers by reviewing the aortography with a marking catheter. RESULTS: The measurements from the 2 modalities were reproducible with intraobserver correlation coefficients of 0.89 to 1.0 for conventional CT and 0.98 to 1.0 for 3D workstation. Interobserver correlation coefficients were 0.29 to 0.95 for conventional CT and 0.85 to 0.99 for the 3D workstation. The length of the aneurysm for proper main graft coincided in 18 and 14 patients according to the conventional CT scan and in 21 and 18 patients according to the 3D workstation, respectively. CONCLUSION: The interobserver agreement in planning EVAR was significantly better with the iNtuition 3D workstation. But aortography with a marking catheter may still be needed for selecting the proper graft.