The Need for Standardized Methods for Measuring the Aorta: Multimodality Core Lab Experience From the GenTAC Registry.
The Need for Standardized Methods for Measuring the Aorta: Multimodality Core Lab Experience From the GenTAC Registry.
- 2016
BACKGROUND: In patients with aortic disease, imaging of thoracic aorta plays a major role in risk stratifying individuals for life-threatening complications and in determining timing of surgical intervention. However, standardization of the procedures for performance of aortic measurements is lacking. CONCLUSIONS: By comparing core laboratory with measurements from clinical centers, our study identified important sources of variability in aortic measurements. Furthermore, our findings with regard to CT and MRI suggest a need for imaging societies to work toward the development of unifying acquisition protocols and common measuring methods. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. METHODS: To characterize the diversity of methods used in clinical practice, we compared aortic measurements performed by echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI) at the 6 GenTAC (National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions) clinical centers to those performed at the imaging core laboratory in 965 studies. Each center acquired and analyzed their images according to local protocols. The same images were subsequently analyzed blindly by the core laboratory, on the basis of a standardized protocol for all imaging modalities. Paired measurements from clinical centers and core laboratory were compared by mean of differences and intraclass correlation coefficient (ICC). OBJECTIVES: This study sought to evaluate variability in aortic measurements with multiple imaging modalities in clinical centers by comparing with a standardized measuring protocol implemented in a core laboratory. RESULTS: For all segments of the ascending aorta, echocardiography showed a higher ICC (0.84 to 0.93) than CT (0.84) and MRI (0.82 to 0.90), with smaller mean of differences. MRI showed higher ICC for the arch and descending aorta (0.91 and 0.93). In a mixed adjusted model, the different imaging modalities and clinical centers were identified as sources of variability between clinical and core laboratory measurements, whereas age groups or diagnosis at enrollment were not.
English
1876-7591
*Aneurysm, Dissecting/dg [Diagnostic Imaging]
*Aorta, Thoracic/dg [Diagnostic Imaging]
*Aortic Aneurysm, Thoracic/dg [Diagnostic Imaging]
*Aortic Rupture/dg [Diagnostic Imaging]
*Aortography/st [Standards]
*Echocardiography/st [Standards]
*Laboratory Proficiency Testing/st [Standards]
*Magnetic Resonance Imaging/st [Standards]
*Tomography, X-Ray Computed/st [Standards]
Adolescent
Adult
Aneurysm, Dissecting/ge [Genetics]
Aortic Aneurysm, Thoracic/ge [Genetics]
Aortic Rupture/ge [Genetics]
Consensus
Female
Humans
Male
Middle Aged
Observer Variation
Predictive Value of Tests
Registries
Reproducibility of Results
Retrospective Studies
United States
Young Adult
MedStar Heart & Vascular Institute
Comparative Study
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
BACKGROUND: In patients with aortic disease, imaging of thoracic aorta plays a major role in risk stratifying individuals for life-threatening complications and in determining timing of surgical intervention. However, standardization of the procedures for performance of aortic measurements is lacking. CONCLUSIONS: By comparing core laboratory with measurements from clinical centers, our study identified important sources of variability in aortic measurements. Furthermore, our findings with regard to CT and MRI suggest a need for imaging societies to work toward the development of unifying acquisition protocols and common measuring methods. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. METHODS: To characterize the diversity of methods used in clinical practice, we compared aortic measurements performed by echocardiography, computed tomography (CT), and magnetic resonance imaging (MRI) at the 6 GenTAC (National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions) clinical centers to those performed at the imaging core laboratory in 965 studies. Each center acquired and analyzed their images according to local protocols. The same images were subsequently analyzed blindly by the core laboratory, on the basis of a standardized protocol for all imaging modalities. Paired measurements from clinical centers and core laboratory were compared by mean of differences and intraclass correlation coefficient (ICC). OBJECTIVES: This study sought to evaluate variability in aortic measurements with multiple imaging modalities in clinical centers by comparing with a standardized measuring protocol implemented in a core laboratory. RESULTS: For all segments of the ascending aorta, echocardiography showed a higher ICC (0.84 to 0.93) than CT (0.84) and MRI (0.82 to 0.90), with smaller mean of differences. MRI showed higher ICC for the arch and descending aorta (0.91 and 0.93). In a mixed adjusted model, the different imaging modalities and clinical centers were identified as sources of variability between clinical and core laboratory measurements, whereas age groups or diagnosis at enrollment were not.
English
1876-7591
*Aneurysm, Dissecting/dg [Diagnostic Imaging]
*Aorta, Thoracic/dg [Diagnostic Imaging]
*Aortic Aneurysm, Thoracic/dg [Diagnostic Imaging]
*Aortic Rupture/dg [Diagnostic Imaging]
*Aortography/st [Standards]
*Echocardiography/st [Standards]
*Laboratory Proficiency Testing/st [Standards]
*Magnetic Resonance Imaging/st [Standards]
*Tomography, X-Ray Computed/st [Standards]
Adolescent
Adult
Aneurysm, Dissecting/ge [Genetics]
Aortic Aneurysm, Thoracic/ge [Genetics]
Aortic Rupture/ge [Genetics]
Consensus
Female
Humans
Male
Middle Aged
Observer Variation
Predictive Value of Tests
Registries
Reproducibility of Results
Retrospective Studies
United States
Young Adult
MedStar Heart & Vascular Institute
Comparative Study
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural